Diferenças entre crianças hospitalizadas com pneumonia adquirida na comunidade em dois hospitais-escola antes e após a implementação da vacina pneumocócica conjugada no Brasil

Abstract

Objective: No previous study compared characteristics of children hospitalized with community-acquired pneumonia (CAP) before and after pneumococcal conjugate vaccine (PCV) implementation in Brazil. We aimed to fill this gap. Methods: Children (4-59-months-old) hospitalized with CAP were included in this prospective, hospital-based study conducted in Brazil, in 2003-2005 (pre-PCV period) and 2018-2020 (post-PCV period). Parents/caregivers were interviewed, medical records were reviewed, and childhood vaccination cards were verified. All radiographs were read by the same pediatric radiologist, blinded to clinical data. Radiologically-confirmed pneumonia was defined as presence of pulmonary infiltrate/pleural effusion. Results: In the pre and post-PCV period 256 and 210 patients, respectively, were eligible. No patient received PCV vaccination in the pre-PCV period and all were fully vaccinated in the post-PCV period, when children were significantly older (24.4[12.8-37.5] vs. 19.4[11.6-31.0] months, p=0.001), rhonchi on physical examination (52.4% vs. 35.1%], Intensive care unit treatment (16.2% vs. 1.4%) and corticosteroid use (60.0% vs. 35.5%) were more frequent (all p<0.001). In the pre-PCV period, detection of fever (62.4% vs. 21.4%), tachypnea (84.6% vs. 37.8%), chest indrawing (55.7% vs. 30.0%), and radiologically-confirmed pneumonia (76.6% vs. 47.1%), were more often (all p<0.001). Conclusion: Vaccinated children were older and received more frequently intensive care and corticosteroids. Among them, detection of fever, tachypnea, chest indrawing and radiologically-confirmed pneumonia decreased. Such differences may be due to possible distinct frequencies of the causative agents of CAP in children secondary to PCV10 implementation.