Background: Community acquired alveolar pneumonia (CAAP) is considered a bacterial disease, mainly pneumococcal. Indeed, CAAP rates were markedly reduced following PCV7/PCV13 introduction worldwide. In contrast, non-CAAP lower respiratory tract infections (LRIs) are generally not considered pneumococcal disease. We assessed overall chest X-ray (CXR) examination, CAAP and non-CAAP rates in southern Israel before and after PCV7/PCV13 introduction.
Methods: Our medical center serves a captive population of ~75,000 children <5y, enabling incidence calculation. Infant PCV7/ PCV13 were implemented in July-2009/November-2010, respectively. All CXR were computerized. Incidence was calculated for Jul-2002 through Jun-2016. Incidence-rate ratios (IRRs and 95%CI) comparing PCV13 (2014-2016) and pre-PCV (2004-2008) periods were calculated.
Results: Mean CAAP and non-CAAP rates (per 1,000 children <5y) significantly declined by 49% (IRR=0.514; 95% CI: 0.482-0.550) and 36% (IRR=0.639; 0.623-0.655), respectively, resulting in a 39% decline in CXR rates (IRR=0.613; 0.599-0.630).
Marked declines in CXR, CAAP and non-CAAP rates were seen in both Jewish and Bedouin children, with generally significantly deeper declines among Jewish children and children >12 months old. (Table 1)
Conclusions: PCV7/PCV13 implementation resulted in a marked and significant decline in both CAAP and non-CAAP rates in children
Future studies are needed to assess the role of pneumococci, other bacteria and viruses in the etiology of LRIs.
