2183. Population-based Mortality Rate Trends of Potential Pneumococcal Pneumonia in Brazil from 2006-2019
Authors: Parellada Cintia I , Bierrenbach Ana Luiza , Zampirolli Carolina , Abreu Ariane , Julian Guilherme , Moreira Thais , Figueiredo Licieri , Carlos Juan 
Published: December 2022

Abstract

Background
Pneumococcal Disease is an important public health problem. In 2010, childhood pneumococcal vaccination with the 10-valent conjugate vaccine (PCV-10) was introduced in the Brazilian national immunization program. No public universal program is currently available for older adults; selected populations at risk are eligible to receive pneumococcal vaccine in few public centers across the country. The objective of this study was to assess trends in mortality rate (MR) due to potential pneumococcal pneumonia (PPP) from 2006-2019 in Brazil.

Methods
Death data were obtained from the Mortality Information System (SIM) and population data from the Brazilian Institute of Geography and Statistics (IBGE). ICD-10 codes included J13-J18. Yearly MR were calculated per 100,000 people. The percentage of change was calculated using average rate in the pre-(2006-2009) and post-PCV10 (2011-2019) vaccine introduction periods. Joinpoint regression was performed to assess changes in rates per 100,000 people and annual percentage changes (APCs) for each line segment and 95% confidence interval were estimated.

Results
During 2006-2019, 887,304 deaths by PPP occurred in all-age groups. Most cases were reported as unspecific pneumonia (99.8%). Mean MRs decreased in children &lt; 5 years in post-PCV10 period, in contrast to increasing rates in adults ≥ 50 years (Table 1 and Figure 1). Among children less than 18 years, significant decreasing trends in MR by 5.5%, 2.9%, and 1.6% per year were observed in &lt; 1year, 1-4 years, and 5-17 years, respectively, between 2006-2019 (Table 2). Although significantly decreasing trends were observed in 60-64 years and ≥65 years age groups during 2015-2019, the average APC increased by 1.0% (95%CI;0.3%;1.8%) and 1.4% (95%CI;0.5%;2.2%) in the post-PCV-10, respectively (Table 2). Table 1.Mean mortality rates by age groups for potential pneumococcal pneumonia in the pre-vaccination period (2006-2009) and post-vaccination period (2011-2019) , BrazilFigure 1.Mortality rate of pneumonia by age group in parallel with infant vaccination coverage, 2006-2019Table 2.Jointpoint analysis for mortality rate trends of potential pneumococcal pneumonia by age groups, Brazil, 2006-2019

Conclusion
In post-PCV10 period, mortality rate of PPP declined mostly for infants. For older adults, the mortality trends have been consistently higher compared to &lt; 18 age groups, being unable to demonstrate indirect effects of childhood vaccination. These findings inform decision makers about needs related to pneumococcal disease prevention and interventions among older adults.

Disclosures
Cintia I. Parellada, MD, PhD, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck & Co., Inc.,|MSD Brazil: Stocks/Bonds Ana Luiza Bierrenbach, MD, PhD, Merck & Co., Inc.: Advisor/Consultant Carolina Zampirolli, Msc, Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Employee of IQVIA who received funding to execute this study Ariane Abreu, Msc, Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Employee of IQVIA who received funding to execute this study Guilherme Julian, Msc, Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Employee of IQVIA who received funding to execute this study Thais Moreira, MD, MSc, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck & Co., Inc.,|MSD Brazil: Stocks/Bonds Licieri Figueiredo, MD, Merck & Co., Inc.: Employee of MSD Brazil, a subsidiary of Merck & Co., Inc.,.