LRTI rates fall by 30% in Indigenous infants but still a long way to go


Bacterial pneumonia hospitalisations in Indigenous infants in the NT have decreased by 30% in recent years thanks to  pneumococcal 13-valent immunisation (PCV13), a new study shows.

Rates of bacterial acute lower respiratory tract infections in infants have shown a significant decline across the eras of 7-valent PCV (2005-2007), 10-valent and 13-valent PCV (after 2011), according to findings published by researchers from the Menzies School of Health Research.

Senior research fellow Dr Michael Binks and colleagues assessed the effect of the implementation of pneumococcal vaccines on LRTI rates in a retrospective review of outcomes for 14,594  Indigenous children born between 2006 and 2016.

They found that 4138 acute LRTI episodes accounted for 31% of all hospitalisations in  among 2888 (20%) of the infants. The overall LRTI hospitalisation rate was 29·7 episodes per 100 child-years.

For bacterial LRTI hospitalistions, the incidence rate fell from 8.4 to 5.6 episodes per 100 child-year between the PC10 and PV13 eras.

The incidence ratio for bacterial LRTI hospitalisation was significantly lower (0·68) in the PCV13 era compared to the PCV10 era and also compared to the PCV7 era (0·70).

The reduction in bacterial LRTI did not appear to be associated with improvements in living conditions, such as better nutrition, hygiene, and health-care services, since there was no change in hospitalisation for LRTIs caused by RSV.

“With consistently high three-dose PCV uptake (approximately 90% by age 12 months) and stable rates of RSV-ALRI hospitalisation across eras, the specific reductions in pneumonia hospitalisations are suggestive of a PCV13 effect,” the study authors said in Lancet Child and Adolescent Health.

However despite the decrease, the study investigators stressed that there were still high rates of acute LRTI in Indigenous children.

This was likely due to risk factors such as maternal smoking (51%), alcohol use in pregnancy (10%), gestational diabetes (15%), and preeclampsia (13%), preterm (14%), and low birthweight babies (13%).

“These factors, coupled with early life malnutrition, overcrowding (54% of remote homes), limited culturally appropriate antenatal and child health care, and inadequate health-related housing infrastructure contribute to the high ALRI burden,” they said.

“Future gains, given the high burden of acute LRTI and its consequences in the Northern Territory, will require alternative strategies including broader valency (15-valent and 20-valent PCVs are in phase 2–3 clinical trials), protein or whole-cell pneumococcal vaccines, maternal vaccination (respiratory syncytial virus and PCVs), nutritional supplementation, smoking cessation, and improved housing,” they suggested.

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