Effect of Pneumococcal Vaccination on U.S. Hospitalization Rates

Summary and Comment |
July 10, 2013

Effect of Pneumococcal Vaccination on U.S. Hospitalization Rates

  1. Larry M. Baddour, MDAU1478

Despite concerns about “replacement” disease, reduced hospitalization rates for pneumonia have been sustained for a decade following introduction of the 7-valent conjugate vaccine.

  1. Larry M. Baddour, MDAU1478

Addition of the 7-valent pneumococcal vaccine (PCV7) to the childhood immunization schedule in 2000 has dramatically reduced the incidence of invasive pneumococcal disease across all age groups. To determine whether “replacement” disease caused by nonvaccine serotypes has eroded some of the gains achieved by PCV7, investigators evaluated hospitalization rates for pneumonia among children and adults.

Data from the Nationwide Inpatient Sample were examined for three periods: 1997–1999 (pre-PCV7); 2001–2006 (early PCV7); and 2007–2009 (late PCV7). The year 2000 was excluded because it was considered a transition period. Records were analyzed for patients with a first-listed discharge diagnosis of pneumonia, or a first-listed discharge diagnosis of meningitis, septicemia, or empyema in addition to a diagnosis of pneumonia in another diagnostic field.

Overall, from 1997 through 2009, 4.1% of all U.S. hospitalizations (excluding those for childbirth) were due to pneumonia. Compared with the pre-PCV7 period, the late-PCV7 period showed an age-adjusted annual reduction in hospitalizations of 54.8 per 100,000 (95% confidence interval, 41.0–68.5), translating to 168,182 fewer hospitalizations in 2009 than would have been expected if pre-PCV7 rates had remained unchanged. The largest absolute and relative reductions were seen at the extremes of age: 43.2% (95% CI, 34.9–51.6), or 47,000 fewer hospitalizations in 2009, for children aged <2 years; and 22.8% (95% CI, 17.3–28.4), or 73,000 fewer hospitalizations, for adults aged ≥85.


Data from the Nationwide Inpatient Sample show a sustained reduction in the rate of hospitalization for pneumonia nearly a decade after the introduction of the 7-valent pneumococcal vaccine. Now, with the availability of the 13-valent pneumococcal vaccine, further reductions in hospitalization rates are expected.

Editor Disclosures at Time of Publication

  • Disclosures for Larry M. Baddour, MD at time of publication Editorial boards UpToDate Leadership positions in professional societies American Heart Association (Chairman, Rheumatic Fever, Endocarditis, Kawasaki Disease Committee)


Reader Comments (1)

SHELDON BALL Physician, Geriatrics, Anvita Health

The use of IM injections to produce IgG in order to provide protection against a respiratory pathogen seems to be a less than optimal strategy. Granted, there is evidence that the pneumococcal polysaccharide vaccine protects against penumococcal septicemia thus reducing mortality in hospitalized patients with pneumococcal pneumonia [1,2]. But how does IgG protect against pneumococcal infection (or influenza infection) within the respiratory epithelia/aveoli of the lungs? This has long puzzled me, but I have never seen this adequately addressed.

1) Musher DM et al,
Effect of pneumococcal vaccination: A comparison of vaccination
rates in patients with bacteremic and nonbacteremic
pneumococcal pneumonia.
Clin Infest Dis 2006, 43:1004
PMID: 16983612
2) Huss A et al
Efficacy of pneumococcal vaccination in adults:
A meta-analysis.
CMAJ 2009 Jan 6; 180:48.
PMID: 19124790
- Andrews R and Moberley SA.
The controversy over the efficacy of pneumococcal vaccine.
CMAJ 2009 Jan 6; 180:18.
PMID: 19124781

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