Pediatrics
December 2014, VOLUME 134 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Article
Sinusitis and Pneumonia Hospitalization After Introduction of Pneumococcal Conjugate Vaccine
Ann Lindstrand, MD, MPHa,b, Rutger Bennet, MD, PhDc, Ilias Galanis, MSca, Margareta Blennow, MD, PhDd,e, Lina Schollin Ask, MDd, Sofia Hultman Dennison, MDf, Malin Ryd Rinder, MD, PhDd, Margareta Eriksson, MD, PhDc, Birgitta Henriques-Normark, MD, PhDa,g,h, Åke Örtqvist, MD, PhDi,j, and Tobias Alfvén, MD, PhDb,d
Author Affiliations
aPublic Health Agency of Sweden, Solna, Sweden;
Departments of bPublic Health Sciences, Division of Global Health,
eClinical Sciences and Education, and
gMicrobiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden;
cAstrid Lindgren Children’s Hospital, and
hDepartment of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden;
dSachs’ Children and Youth Hospital, South General Hospital, Stockholm, Sweden;
fDepartment of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden;
iDepartment of Communicable Disease Control and Prevention, Stockholm County Council, Sweden; and
jDepartment of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Karolinska, Solna, Sweden
Abstract
BACKGROUND AND OBJECTIVE:Streptococcus pneumoniae is a major cause of pneumonia and sinusitis. Pneumonia kills >1 million children annually, and sinusitis is a potentially serious pediatric disease that increases the risk of orbital and intracranial complications. Although pneumococcal conjugate vaccine (PCV) is effective against invasive pneumococcal disease, its effectiveness against pneumonia is less consistent, and its effect on sinusitis is not known. We compared hospitalization rates due to sinusitis, pneumonia, and empyema before and after sequential introduction of PCV7 and PCV13.
METHOD: All children 0 to <18 years old hospitalized for sinusitis, pneumonia, or empyema in Stockholm County, Sweden, from 2003 to 2012 were included in a population-based study of hospital registry data on hospitalizations due to sinusitis, pneumonia, or empyema. Trend analysis, incidence rates, and rate ratios (RRs) were calculated comparing July 2003 to June 2007 with July 2008 to June 2012, excluding the year of PCV7 introduction.
RESULTS: Hospitalizations for sinusitis decreased significantly in children aged 0 to <2 years, from 70 to 24 cases per 100 000 population (RR = 0.34, P < .001). Hospitalizations for pneumonia decreased significantly in children aged 0 to <2 years, from 450 to 366 per 100 000 population (RR = 0.81, P < .001) and in those aged 2 to <5 years from 250 to 212 per 100 000 population (RR = 0.85, P = .002). Hospitalization for empyema increased nonsignificantly. Trend analyses showed increasing hospitalization for pneumonia in children 0 to <2 years before intervention and confirmed a decrease in hospitalizations for sinusitis and pneumonia in children aged 0 to <5 years after intervention.
CONCLUSIONS: PCV7 and PCV13 vaccination led to a 66% lower risk of hospitalization for sinusitis and 19% lower risk of hospitalization for pneumonia in children aged 0 to <2 years, in a comparison of 4 years before and 4 years after vaccine introduction.

Article
Changes in Child Mortality Over Time Across the Wealth Gradient in Less-Developed Countries
Eran Bendavid, MD, MSa,b
Author Affiliations
aDivision of General Medical Disciplines, and
bCenter for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
Abstract
BACKGROUND: It is unknown whether inequalities in under-5 mortality by wealth in low- and middle-income countries (LMICs) are growing or declining.
METHODS: All Demographic and Health Surveys conducted between 2002 and 2012 were used to measure under-5 mortality trends in 3 wealth tertiles. Two approaches were used to estimate changes in under-5 mortality: within-survey changes from all 54 countries, and between-survey changes for 29 countries with repeated survey waves. The principal outcome measures include annual decline in mortality, and the ratio of mortality between the poorest and least-poor wealth tertiles.
RESULTS: Mortality information in 85 surveys from 929 224 households and 1 267 167 women living in 54 countries was used. In the subset of 29 countries with repeat surveys, mortality declined annually by 4.36, 3.36, and 2.06 deaths per 1000 live births among the poorest, middle, and least-poor tertiles, respectively (P = .031 for difference). The mortality ratio declined from 1.68 to 1.48 during the study period (P = .006 for trend). In the complete set of 85 surveys, the mortality ratio declined in 64 surveys (from 2.11 to 1.55), and increased in 21 surveys (from 1.58 to 1.88). Multivariate analyses suggest that convergence was associated with good governance (P ≤ .03 for 4 governance indicators: government effectiveness, rule of law, regulatory quality, and control of corruption).
CONCLUSIONS: Overall, under-5 mortality in low- and middle-income countries has decreased faster among the poorest compared with the least poor between 1995 and 2012, but progress in some countries has lagged, especially with poor governance.

Article
Adolescent Vaccine Co-administration and Coverage in New York City: 2007–2013
Monica Sull, MPHa, Joanna Eavey, MSPHa,b, Vikki Papadouka, PhD, MPHa, Rebecca Mandell, MSa,c, Michael A. Hansen, MPHa,d, and Jane R. Zucker, MD, MSca,e
Author Affiliations
aBureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York;
bCenter for Health Statistics, Washington Department of Health,
cDepartment of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan;
dAtlantic Management Center, Inc., Columbus, Ohio; and
eImmunization Services Division/National Center for Immunization and Respiratory Diseases/Centers for Disease Control & Prevention, Atlanta, Georgia
Abstract
OBJECTIVES: To investigate adolescent vaccination in New York City, we assessed tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal conjugate (MCV4), and human papillomavirus (HPV) vaccine uptake, vaccine co-administration, and catch-up coverage over time.
METHODS: We analyzed data from the Citywide Immunization Registry, a population-based immunization information system, to measure vaccine uptake and co-administration, defined as a Tdap vaccination visit where MCV4 or HPV vaccine was co-administered, among 11-year-olds. Catch-up vaccinations were evaluated through 2013 for adolescents born 1996 to 2000, by birth cohort. HPV vaccination among boys included data from 2010 to 2013.
RESULTS: Adolescent vaccine administration was greatest during the back-to-school months of August to October and was highest for Tdap. Although MCV4 uptake improved over the study years, HPV vaccine uptake among girls stagnated; boys achieved similar uptake of HPV vaccine by 2012. By 2013, 65.4% had MCV4 co-administered with Tdap vaccine, whereas 28.4% of girls and 25.9% of boys had their first dose of HPV vaccine co-administered. By age 17, Tdap and MCV4 vaccination coverage increased to 97.5% and 92.8%, respectively, whereas ≥1-dose and 3-dose HPV vaccination coverage were, respectively, 77.5% and 53.1% for girls and 49.3% and 21.6% for boys. Age-specific vaccination coverage increased with each successive birth cohort (P < .001).
CONCLUSIONS: From 2007 to 2013, there were greater improvements in Tdap and MCV4 vaccination than HPV vaccination, for which co-administration with Tdap vaccine and coverage through adolescence remained lower. Parent and provider outreach efforts should promote timely HPV vaccination for all adolescents and vaccine co-administration.