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- Title
Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Following Implementation of the 13-Valent Pneumococcal Conjugate Vaccine in France.
- Authors
Assad, Zein; Michel, Morgane; Valtuille, Zaba; Lazzati, Andrea; Boizeau, Priscilla; Madhi, Fouad; Gaschignard, Jean; Pham, Luu-Ly; Caseris, Marion; Cohen, Robert; Kaguelidou, Florentia; Varon, Emmanuelle; Alberti, Corinne; Faye, Albert; Angoulvant, François; Koehl, Bérengère; Ouldali, Naïm
- Abstract
Key Points: Question: Is the implementation of 13-valent pneumococcal conjugate vaccine (PCV13) in the general pediatric population associated with a change in the incidence of acute chest syndrome (ACS) in children with sickle cell disease? Findings: This cohort study including 107 694 hospitalizations used interrupted time series analysis of a prospective national surveillance cohort from 2007 to 2019. There was a significant decrease in the incidence of ACS after PCV13 implementation in 2010. Meaning: These results provide new evidence of the key role of Streptococcus pneumoniae in ACS and should be considered when estimating the public health benefit of current and next-generation pneumococcal conjugate vaccines in children. This cohort study of children with sickle cell disease (SCD) in a French hospital system examines the association of 13-valent pneumococcal conjugate vaccine implementation with incidence of acute chest syndrome (ACS). Importance: Acute chest syndrome (ACS) is one of the leading acute severe complications of sickle-cell disease (SCD). Although Streptococcus pneumoniae (S pneumoniae) is highly prevalent in children with SCD, its precise role in ACS is unclear. The efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) implementation on ACS is still unknown. Objective: To assess the association of PCV13 implementation in the general pediatric population with the incidence of ACS in children with SCD. Design, Setting, and Participants: This cohort study used an interrupted time-series analysis of patient records from a national hospital-based French surveillance system. All children younger than 18 years with SCD (based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision definition) hospitalized in France between January 2007 and December 2019 were included. Exposures: PCV13 implementation. Main Outcomes and Measures: Monthly incidence of ACS per 1000 children with SCD over time as analyzed by segmented linear regression with autoregressive error; monthly incidence of hospitalization for vaso-occlusive crisis, asthma crisis, and acute pyelonephritis per 1000 children with SCD over the same period as the control outcomes. Results: Among the 107 694 hospitalizations of children with SCD, 4007 episodes of ACS were included (median [IQR] age, 8 [4-12] years; 2228 [55.6%] boys). PCV13 implementation in 2010 was followed by a significant decrease in the incidence of ACS (−0.9% per month; 95% CI, −1.4% to −0.4%; P <.001), with an estimated cumulative change of −41.8% (95% CI, −70.8% to −12.7%) by 2019. Sensitivity analyses yielded the same results, including the incidence of ACS adjusted for that of vaso-occlusive crisis over time. The results were similar among different age groups. By contrast, no change was found for the 3 control outcomes over the study period. Conclusions and Relevance: PCV13 implementation was associated with an important reduction in the incidence of ACS in children with SCD. This vaccine benefit provides new evidence of the key role of S pneumoniae in ACS and should be considered when estimating outcomes associated with current PCVs and the potential benefit of next-generation PCVs in children.
- Subjects
FRANCE; MEDICAL information storage &; retrieval systems; PNEUMOCOCCAL vaccines; HUMAN services programs; TREATMENT effectiveness; TIME series analysis; MEDICAL records; ACUTE chest syndrome; SICKLE cell anemia; LONGITUDINAL method
- Publication
JAMA Network Open, 2022, Vol 5, Issue 8, pe2225141
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.25141