Association between Respiratory Syncytial Virus Activity and Pneumococcal Disease in Infants: A Time Series Analysis of US Hospitalization Data

The importance of bacterial infections following respiratory syncytial virus (RSV) remains unclear. We evaluated whether variations in RSV epidemic timing and magnitude are associated with variations in pneumococcal disease epidemics and whether changes in pneumococcal disease following the introduc...

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Vydáno v:	PLoS medicine Ročník 12; číslo 1; s. e1001776
Hlavní autoři:	Weinberger, Daniel M., Klugman, Keith P., Steiner, Claudia A., Simonsen, Lone, Viboud, Cécile
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 01.01.2015 Public Library of Science (PLoS)
Témata:	Bacterial infections Biology and Life Sciences Health aspects Heptavalent Pneumococcal Conjugate Vaccine - administration & dosage Hospitalization - statistics & numerical data Hospitalization - trends Host-parasite relationships Humans Identification and classification Immunization Incidence Infant Infant, Newborn Infants Medicine and Health Sciences Pneumonia Pneumonia, Pneumococcal - epidemiology Pneumonia, Pneumococcal - prevention & control Pneumonia, Pneumococcal - virology Prevalence Respiratory syncytial virus Respiratory Syncytial Virus Infections - epidemiology Respiratory Syncytial Virus Infections - microbiology Respiratory Syncytial Virus Infections - prevention & control Respiratory Syncytial Virus Infections - virology Respiratory Syncytial Virus, Human - isolation & purification Seasons Streptococcus pneumoniae Studies Time series Time series analysis United States - epidemiology Vaccines United States
ISSN:	1549-1676, 1549-1277, 1549-1676
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Shrnutí:	The importance of bacterial infections following respiratory syncytial virus (RSV) remains unclear. We evaluated whether variations in RSV epidemic timing and magnitude are associated with variations in pneumococcal disease epidemics and whether changes in pneumococcal disease following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7) were associated with changes in the rate of hospitalizations coded as RSV. We used data from the State Inpatient Databases (Agency for Healthcare Research and Quality), including >700,000 RSV hospitalizations and >16,000 pneumococcal pneumonia hospitalizations in 36 states (1992/1993-2008/2009). Harmonic regression was used to estimate the timing of the average seasonal peak of RSV, pneumococcal pneumonia, and pneumococcal septicemia. We then estimated the association between the incidence of pneumococcal disease in children and the activity of RSV and influenza (where there is a well-established association) using Poisson regression models that controlled for shared seasonal variations. Finally, we estimated changes in the rate of hospitalizations coded as RSV following the introduction of PCV7. RSV and pneumococcal pneumonia shared a distinctive spatiotemporal pattern (correlation of peak timing: ρ = 0.70, 95% CI: 0.45, 0.84). RSV was associated with a significant increase in the incidence of pneumococcal pneumonia in children aged <1 y (attributable percent [AP]: 20.3%, 95% CI: 17.4%, 25.1%) and among children aged 1-2 y (AP: 10.1%, 95% CI: 7.6%, 13.9%). Influenza was also associated with an increase in pneumococcal pneumonia among children aged 1-2 y (AP: 3.2%, 95% CI: 1.7%, 4.7%). Finally, we observed a significant decline in RSV-coded hospitalizations in children aged <1 y following PCV7 introduction (-18.0%, 95% CI: -22.6%, -13.1%, for 2004/2005-2008/2009 versus 1997/1998-1999/2000). This study used aggregated hospitalization data, and studies with individual-level, laboratory-confirmed data could help to confirm these findings. These analyses provide evidence for an interaction between RSV and pneumococcal pneumonia. Future work should evaluate whether treatment for secondary bacterial infections could be considered for pneumonia cases even if a child tests positive for RSV. Please see later in the article for the Editors' Summary.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 DMW has received research support for other projects from an investigator initiated research grant from Pfizer to Yale University. LS and KPK have previously received research support from Pfizer. DMW has received consulting fees from Merck. KPK is a member of the Editorial Board of PLOS Medicine. The other authors have declared that no competing interests exist. Conceived and designed the experiments: DMW CV LS KPK. Performed the experiments: DMW. Analyzed the data: DMW. Contributed reagents/materials/analysis tools: CAS. Wrote the first draft of the manuscript: DMW. Wrote the paper: DMW CAS CV KPK LS. ICMJE criteria for authorship read and met: DMW CAS CV KPK LS. Agree with manuscript results and conclusions: DMW CAS CV KPK LS.
ISSN:	1549-1676 1549-1277 1549-1676
DOI:	10.1371/journal.pmed.1001776