Highlights ► We analyzed Hib meningitis rates in four South American countries using Hib vaccine. ► Hib vaccination schedules included 3 doses and a booster dose in two countries. ► Vaccination ...reduced Hib meningitis incidence to low levels. ► Low incidence rates were maintained in countries with and without a booster dose.
To assess the effectiveness of a Hib vaccination program against X-ray defined bacterial pneumonia in children <2 years in Colombia.
389 cases of radiologically confirmed pneumonia were recruited ...from hospitals in Bogotá and Medellin, Colombia. Two controls per case, matched on age, sex, and socio-economic level, were selected from children attending child health services at the hospitals where pneumonia cases were admitted.
The risk of having X-ray confirmed pneumonia decreased with each Hib dose received; the vaccine effectiveness was 47% (2–72%) among those receiving one dose; 52% for two doses received, and 55% for three doses. These effectiveness levels remained after adjusting for other factors associated with risk of pneumonia.
This study indicates that trials may have underestimated the proportion of radiological pneumonia in the under 2s that is due to Hib. This suggests that the impact of the vaccination will be greater than expected if it can be extended to reach the poorest children, who are at the greatest risk.
OBJETIVOS: Analizar los costos de las neumonías presuntamente virales y bacterianas diagnosticadas por radiografía en centros de referencia de tres ciudades colombianas. MÉTODOS: Se estudiaron 128 ...casos de neumonía, 64 bacterianas y 64 virales, que ingresaron consecutivamente a los hospitales del estudio en Cartagena, Medellín y Santa Fe de Bogotá entre julio de 2001 y enero de 2003. Los diagnósticos de neumonía se fundamentaron en la radiografía de tórax y la población de estudio se compuso de niños menores de 2 años que requirieron hospitalización. Para estimar los costos de cada intervención se utilizó el método de determinación de costos por actividad para cada caso, después de lo cual se estimaron los costos medios. RESULTADOS: Los costos de las neumonías presuntamente bacterianas fueron de 611,50 dólares estadounidenses (US$) (IC95%, 532,20-690,80) y los de las presuntamente virales, de 472,20 US$ (IC95%, 331,80-612,60). Las diferencias observadas se explican por los costos directos, en particular de los medicamentos (antibióticos), servicios especiales y pruebas diagnósticas. Dada la similar procedencia de las familias de ambas poblaciones, los costos indirectos no mostraron diferencias y su participación en los costos totales no se consideró relevante. CONCLUSIONES: El estudio reveló diferencias en los costos de la atención de las neumonías presuntamente bacterianas y virales, y se aproximó a los costos indirectos generados por estas entidades patológicas. Tales diferencias permiten inferir que el método de diagnóstico utilizado, que fue la radiografía de tórax, tuvo la capacidad de diferenciar los sucesos de interés. Puesto que en la Región son escasos los estudios económicos que valoren los costos de la neumonía en niños, el presente puede servir de referencia para futuras investigaciones sobre el impacto de las intervenciones en las neumonías.
Aims: To assess the effectiveness of a Hib vaccination program against X-ray defined bacterial pneumonia in children <2 years in Colombia. Methods: 389 cases of radiologically confirmed pneumonia ...were recruited from hospitals in Bogotá and Medellin, Colombia. Two controls per case, matched on age, sex, and socio-economic level, were selected from children attending child health services at the hospitals where pneumonia cases were admitted. Results: The risk of having X-ray confirmed pneumonia decreased with each Hib dose received; the vaccine effectiveness was 47% (2-72%) among those receiving one dose; 52% for two doses received, and 55% for three doses. These effectiveness levels remained after adjusting for other factors associated with risk of pneumonia. Conclusions: This study indicates that trials may have underestimated the proportion of radiological pneumonia in the under 2s that is due to Hib. This suggests that the impact of the vaccination will be greater than expected if it can be extended to reach the poorest children, who are at the greatest risk.
To analyze the costs of pneumonias presumed to be of viral or bacterial origin, as diagnosed by chest X ray, in four reference center hospitals in three cities in Colombia.
A total of 128 cases of ...pneumonia (64 bacterial cases and 64 viral cases) that had consecutively entered the hospitals in the study between July 2001 and January 2003 were investigated. The diagnosis of pneumonia was based on chest X rays. The study population was composed of children under 2 years of age who required hospitalization. In order to estimate the costs for bacterial pneumonias and viral pneumonias, the cost of each activity was determined for each case, and then average costs were calculated.
The average cost of the presumably bacterial pneumonia cases was US $611.50 (95% confidence interval (95% CI), US $532.20-690.80); that of the presumably viral cases was US $472.20 (95% CI, US $331.80-612.60). The observed differences were due to direct expenses, especially drugs (antibiotics), special services, and diagnostic tests. In the two groups the families were similar in their incomes and the indirect costs that they had to bear, so the indirect costs were not considered relevant in terms of distinguishing between the costs caused by the two forms of pneumonia.
The study found differences in the direct costs of care between the presumably bacterial cases and the presumably viral ones. The study results also gave an approximation of the indirect costs to the patients' families caused by the pneumonias. The differences found in the direct costs also indicate that X-ray diagnosis is useful for differentiating between viral and bacterial pneumonia. Few studies in Latin America have assessed the economic costs of pneumonia in children, so this study can serve as a reference for future research on the impact of interventions against pneumonia.
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