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Vaccine. 2013 Dec 16;31(52):6232-8. doi: 10.1016/j.vaccine.2013.10.032. Epub 2013 Oct 29.

Prompt effect of replacing the 7-valent pneumococcal conjugate vaccine with the 13-valent vaccine on the epidemiology of invasive pneumococcal disease in Norway.

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Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address:


The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the childhood immunisation programme in Norway in 2006 substantially decreased the incidence of vaccine-type (VT) invasive pneumococcal disease (IPD) in all age groups. Additionally, a slight increase in the non-vaccine (NVT) serotype IPD incidence (serotype replacement) was observed. After replacing PCV7 with PCV13 in 2011, a further decrease in IPD incidence is expected. However, the protection by the six additional serotypes opens new nasopharyngeal niches for colonisation, which favours conditions for serotype replacement. Close monitoring of IPD therefore remains important in order to quickly detect changes. In this observational retrospective population-based cohort study we used data notified nationally between 1 January 2004 and 31 December 2012 to determine the VT- and NVT-IPD incidences. The diversity in serotype distribution per year was analysed using the Simpson's index of diversity. Immunisation history of young children was obtained from the Norwegian Vaccination Registry to determine vaccine failure. The incidence of VT-IPD decreased in the targeted (<5 years) and non-targeted (≥5) age groups since PCV7 introduction and further decreased after the replacement with PCV13. Only two cases of vaccine failure were identified. This indicates very high effectiveness of the 2+1 schedules with PCV7 or PCV13 and suggests that non-vaccinated individuals profit through indirect protection. The decrease in incidence of PCV7-IPD in non-targeted age groups became larger in later years, indicating a lag phase for the indirect effects, and suggests that the indirect protection of PCV13 will increase in coming years. The incidence of some NVT, specifically serotypes 23B and 15A, increased after PCV13 introduction. This coincided with an increased Simpson's index of diversity in the targeted age group. As this suggests that serotype replacement is again occurring, continues monitoring of IPD is important so that adaptations to vaccine recommendations can be promptly issued.


13-Valent pneumococcal conjugate vaccine; 13-valent pneumococcal conjugate vaccine; 23-valent polysaccharide vaccine; 7-Valent pneumococcal conjugate vaccine; 7-valent pneumococcal conjugate vaccine; Childhood immunisation programme; Epidemiology; IPD; Indirect protection; MSIS; NIPH; NVT; Norwegian Immunisation Registry; Norwegian Institute of Public Health; Norwegian Surveillance System for Communicable Diseases; PCV13; PCV13-7; PCV7; PPV23; SYSVAK; Serotype replacement; Simpson's index of diversity; Streptococcus pneumoniae; VT; invasive pneumococcal disease; non-vaccine serotypes; nonPCV13; nonPCV7; serotypes not included in PCV13; serotypes not included in PCV7; six additional serotypes that are in PCV13 but not in PCV7; vaccine serotypes

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