Burden and cost of hospital admissions for vaccine-preventable paediatric pneumococcal disease and non-typable Haemophilus influenzae otitis media in New Zealand
- First Online:
Streptococcus pneumoniae (Sp.) is a leading cause of paediatric bacterial meningitis, pneumonia and acute otitis media, as is non-typable Haemophilus influenzae (NTHi) for acute otitis media. In 2008, a 7-valent conjugated pneumococcal vaccine (PCV7) was included in the New Zealand (NZ) childhood immunization schedule.
To estimate the potentially vaccine-preventable annual hospital admissions and cost to the NZ Government of paediatric admissions for pneumococcal disease and NTHi otitis media prior to the immunization programme.
Admissions (2000–7) and deaths (2000–5) in children aged <20 years with pneumococcal meningitis or bacteraemia, pneumonia or otitis media were identified in national datasets and linked by unique patient identifiers. New episodes of illness were defined as admissions occurring >30 days after discharge from a previous admission. Informed by the literature, pneumococcal pneumonia episodes were estimated at 33% of all-cause pneumonia admissions; Sp. and NTHi otitis media episodes were estimated jointly at 72% of otitis media admissions. Each episode was assigned a single diagnosis according to the following hierarchy: meningitis > bacteraemia > pneumonia > otitis media. Incidence rates for episodes were determined for 2000–7 (meningitis, bacteraemia and pneumonia) and 2006–7 (otitis media). Annual DRG-based costs for pneumococcal meningitis, bacteraemia, pneumonia and otitis media were estimated as (episode rate) × (DRG cost weight per episode) × (2007 population) × (national price per cost weight).
Episode rates for pneumococcal meningitis, bacteraemia and pneumonia were stable in 2000–7, highest in the second 6 months of life and declined steeply over the first 5 years of life. Mean rates per 100 000 in 2000–7 were 18.4, 27.6 and 464 for pneumococcal meningitis, bacteraemia and pneumonia, respectively, for children aged <2 years; 8.4, 14.9 and 295 for children aged <5 years (including those aged <2 years); and 2.2, 4.4 and 97 for children aged <20 years (including those aged <5 years). Mean rates per 100 000 in 2006–7 for Sp. and NTHi otitis media combined were 631 (surgical) and 197 (medical) for children aged <2 years; 691 and 116 for children aged <5 years; and 281 and 35 for children aged <20 years. Pacific Island and indigenous Māori children generally had higher rates than European/other children. Rates increased with socioeconomic disadvantage, across all diagnoses. The annual cost to Government of pneumococcal disease and NTHi otitis media admissions for children aged <20 years was estimated at New Zealand dollars ($NZ)9.95 million (range 7.7–12.2 million) [about $US7.1 million]. Most of this cost was shared between pneumococcal pneumonia (48%) and otitis media (45%), and 78% was incurred in the first 2 years of life. Estimated annual paediatric mortality rates per 100 000 for children aged <5 years were 0.48, 0.30 and 0.54 for pneumococcal meningitis, bacteraemia and pneumonia, respectively. The analysis predicted four or five pneumococcal deaths per year (range 1–8) for children aged <5 years.
Prior to the introduction of a national Sp. immunization programme, hospital admissions for Sp. disease and NTHi otitis media in NZ cost about $NZ10 million annually, mostly for children aged <2 years and particularly for those living in relative socioeconomic deprivation and for Pacific Island and Māori children. There were about five pneumococcal deaths annually. With adjustment for local serotypes, vaccine serotype coverage and uptake, immunization with any of the three available pneumococcal vaccines would reduce this burden substantially.
- 5.Roche PW, Krause V, Cook H, et al. Invasive pneumococcal disease in Australia, 2006. Commun Dis Intell 2008 Mar; 32(1): 18–30Google Scholar
- 10.Prymula R, Peeters P, Chrobok V, et al. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet 2006 Mar 4; 367(9512): 740–8PubMedCrossRefGoogle Scholar
- 11.WHO. Pneumococcal vaccines: WHO position paper. Wkly Epidemiol Rec 1999; 74: 177–84Google Scholar
- 16.Craig E, Jackson C, Han D, et al. Monitoring the health of New Zealand children and young people. Auckland: Paediatric Society of New Zealand, New Zealand Child and Youth Epidemiology Service, 2007Google Scholar
- 18.Centers for Disease Control and Prevention. Pneumonia hospitalizations among young children before and after introduction of pneumococcal conjugate vaccine-United States, 1997–2006. MMWR Morb Mort Wkly Rep 2009 Jan 16; 58(1): 1–4Google Scholar
- 21.Leibovitz E, Jacobs MR, Dagan R. Haemophilus influenzae: a significant pathogen in acute otitis media. Paediatr Infect Dis J 2004 Dec; 23(12): 1142–52Google Scholar
- 26.Ministry of Health. Immunisation handbook. Wellington: Ministry of Health, 2006Google Scholar
- 32.Greville Consulting. New Zealand vision and hearing screening report July 2005–June 2006. Auckland: National Audiology Centre, 2006Google Scholar
- 35.World Health Organization. International statistical classification of diseases and related health problems, 10th revision, version for 2007: tabular list of inclusions and four-character subcategories [online]. Available from URL: http://apps.who.int/classifications/apps/icd/icd10online/ [Accessed 2010 Jul 22]
- 36.Giorgi Rossi P, Agabiti N, Faustini A, et al. The burden of hospitalised pneumonia in Lazio, Italy, 1997–1999. Int J Tuberc Lung Dis 2004 May; 8(5): 528–36Google Scholar
- 38.Jackson CJ, Lennon D, Heffernan H, et al. Estimating invasive pneumococcal disease burden in New Zealand children: comparison of hospitalisation data with active and passive surveillance data. 7th International Symposium on Pneumococci and Pneumococcal Paediatric Diseases; 2010 Mar 14–18; Tel AvivGoogle Scholar
- 40.Salmond C, Crampton P, Atkinson J. NZDep2006: index of deprivation 2007. Wellington: Department of Public Health, Wellington School of Medicine and Health Sciences, 2007 [online]. Available from URL: http://www.uow.otago.ac.nz/academic/dph/research/NZDep/NZDep2006%20research%20report%2004%20September%202007.pdf [Accessed 2010 Jul 22]Google Scholar
- 41.Statistics New Zealand [online]. Available from URL: http://www.stats.govt.nz/ [Accessed 2010 Jul 22]
- 47.Grant C, Milne R. What does pneumonia cost New Zealand? In: Asher I, Byrnes C, editors. Catching our breath. Auckland: Paediatric Society of New Zealand, 2006: 12–3Google Scholar
- 54.Ministry of Health. Immunisation coverage: national and DHB data [online]. Available from URL: http://www.moh.govt.nz/moh.nsf/indexmh/immunisation-coverage-data [Accessed 2010 Jul 22]
- 56.Hansen J, Black S, Shinefield H, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs. Paediatr Infect Dis J 2006 Sep; 25(9): 779–81CrossRefGoogle Scholar
- 67.Jansen A. Pneumococcal infection in preschool children: incidence of acute otitis media and pneumonia related to influenza and respiratory syncytila virus circulation [abstract]. Presented at the ISPPD 5th International Symposium on Pneumococci and Pneumococcal Diseases; 2006 Apr 2–6; Alice Springs (NT)Google Scholar
- 72.Ministry of Health. Discharges from privately funded hospitals: 1 July 2004 to 30 June 2005 [online]. Available from URL: http://www.moh.govt.nz/moh.nsf/indexmh/discharges-privately-funded-hospitals-0405-nov09 [Accessed 2010 Jul 22]
- 78.Centers for Disease Control (CDC). Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal vaccine on incidence of invasive pneumococcal disease: United States, 1998–2003. MMWR Morb Mortal Wkly Rep 2005; 54: 893–7Google Scholar