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Vadlamudi, Nirma Khatri

University of British Columbia

BACKGROUND: Streptococcus pneumoniae causes substantial health and economic burden. Two vaccines available to combat pneumococcal disease are the 23-valent pneumococcal polysaccharide vaccine (PPV23) for adults and the 13-valent pneumococcal conjugate vaccine (PCV13) for children. This thesis evaluated changes in health and economic burden from pneumococcal disease following the PCV13 introduction in the infant immunization program in British Columbia (BC), Canada. METHODS: A literature search and meta-analyses determined the indirect effect of the PCV13 childhood immunization on invasive pneumococcal disease (IPD) among adults worldwide. Then, pneumococcal disease, i.e., IPD, and acute otitis media (AOM), acute sinusitis (AS), and community-acquired pneumonia (CAP) cases and associated healthcare costs were identified using administrative databases for the years 2000-2018. Costs were adjusted to 2018 Canadian dollars. Changes in the incidence, annual healthcare utilization, and associated costs for pneumococcal disease were evaluated across vaccine eras (pre-PCV13 era: 2000-2010, PCV13 era: 2011-2018) using generalized linear models and adjusted for the PCV7 program (2004-2010). RESULTS: A substantial decline in overall IPD (18%), PCV7 (55%), and PCV13 (40%) serotype IPD were observed among adults following the PCV13 vaccine use in the infant immunization program globally. However, a concurrent 112% increase in non-vaccine serotype IPD occurred during the PCV13 period. Similar declines in overall IPD (18%), PCV7-related (70%), and PCV13-related (24%) vaccine serotype IPD among adults and increase in non-vaccine serotype (NVT) IPD (154%) were noted in BC. A substantial rate reduction in AOM (30%) and AS (15%) across all ages was recorded. Although CAP incidence decreased among young children aged 0-2 years (9%), there was a modest increase in the older age groups: 50-64 years (7%), and ≥65 years (5%). As such, temporal declines in total annual cost were observed in the PCV13 era for IPD (27%), AOM (30%), and AS (32%) compared to the pre-PCV13 era, but not CAP, where an increase of 4% in total costs was seen across all ages. CONCLUSIONS: Increasing NVT IPD and pneumonia rates in the post-PCV13 necessitates a need for newer vaccines and stresses the importance of improving public health messaging to increase the PPV23 uptake rates.

Text

2023-01-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/80474

Pharmaceutical Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/