Introduction In November 2015, the Joint Committee on Vaccination and Immunisation (JCVI) recommended against including PCV13 for age based and risk based populations.¹ A principal driver of this recommendation was the incidence of hospitalised pneumococcal pneumonia, reported by Rodrigo et al.² Using the Results from the study by Rodrigo et al a simple calculation can be performed to approximate the incidence of vaccine preventable pneumococcal CAP from all cause hospitalised CAP (ACH-CAP). The national Hospital Episodes Statistics (HES) database³ reports a significantly higher incidence of ACH-CAP which could impact the potential benefit provided by PCV13.

Aim To compare the incidence of ACH-CAP reported in the study by Rodrigo et al.² with the incidence of ACH-CAP coded in HES in the corresponding population, over a similar period of time.

Materials and Methods The study by Rodrigo et al ran from September 2008 for 5 years. Inpatients≥16 years old, with symptoms suggestive of lower respiratory tract, new CXR infiltrates consistent with pneumonia, and treated for CAP, were included.² Our HES analysis included patients≥18 years old with (ICD-10) codes J12–J18⁴ (April 2008 – March 2013) admitted to the hospitals in Rodrigo’s study (Nottingham University Hospitals NHS Trust – City Campus and Queen’s Medical Centre Campus).

Results Rodrigo and colleagues identified 2702 adults while our analysis of HES identified 11 059 across both sites.

Conclusion The study by Rodrigo et al was not specifically designed to capture total incidence of ACH-CAP, instead its objective was to report on pneumococcal serotype evolution.² Miscoding and misdiagnosis of pneumonia in HES is well-recognised⁵ but doesn’t appear to explain the four-fold difference in these numbers. Further investigation to validate HES data against hospital records could be performed. Accurate incidence data would impact cost-effectiveness analyses and facilitate a more informed decision next time the data is reviewed.

Please refer to page A257 for declarations of interest in relation to abstract S6.

References

1. https://app.box.com/s/iddfb4ppwkmtjusir2tc/1/2199012147/22846051967/1

2. Rodrigoet al. Eur Respir J 2015;45:1632–1641.

3. http://content.digital.nhs.uk/hes

4. http://www.icd10data.com/ICD10CM/Codes

5. Danielet al. Thorax 2017;72(4):376–379.