Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Brian Wahl

Second Advisor

Inci Yildirim

Abstract

Pneumococcal conjugate vaccines have significantly reduced pneumonia cases, hospitalizations, and deaths worldwide. This study evaluates the impact of 10-valent pneumococcal conjugate vaccine (PCV10) eligibility on pediatric pneumonia hospitalizations in Nepal using administrative hospital data from three major geographically and administratively diverse hospitals. A controlled interrupted time series design was used comparing pneumonia hospitalizations with diarrhea hospitalizations, under the assumption that PCV10 would not influence diarrhea hospitalization rates. A secondary model stratified hospitalizations by age group, assessing differential trends based on vaccine eligibility. Generalized linear models with quasipoisson distributions were used, adjusting for hospital and seasonality.The primary model comparing pneumonia to diarrhea hospitalizations did not identify a significant differential trend following vaccine introduction (RR = 1.00, 95% CI 0.98-1.01). Importantly, both pneumonia and diarrhea hospitalizations jumped immediately after rollout (RR = 1.57, 95% CI 1.29-1.91; RR = 1.65, 95% CI 1.15-2.39), likely reflecting external factors such as the 2015 Gorkha earthquake rather than vaccine effect. Results of the age-stratified analysis revealed a gradual decline in pneumonia hospitalizations over time among older children who became vaccine-eligible later (RR = 0.98, 95% CI 0.96-1.00). No immediate reduction was observed following eligibility (RR = 1.70, 95% CI 0.85-3.31), but gradual decreases support a delayed vaccine effect. These findings demonstrate how administrative data can be used to monitor vaccine impact at the population level, offering a valuable approach for strengthening evidence-based immunization programs in low-resource settings.

Comments

This is an Open Access Thesis.

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