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Lancet Respir Med. 2014 Jun;2(6):464-71. doi: 10.1016/S2213-2600(14)70060-8. Epub 2014 Apr 10.

Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study.

Author information

1
National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Brazil; Center for Tropical Medicine, University of Brasília, Brasília, Brazil. Electronic address: carla.domingues@saude.gov.br.
2
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
3
National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Brazil.
4
National Reference Laboratory for Meningitis and Pneumococcal Infections, Bacteriology Center, Adolfo Lutz Institute, Secretary of Health of the State of São Paulo, São Paulo, Brazil.
5
Pan American Health Organization, Brasília, Brazil.
6
Pan American Health Organization, Washington, DC, USA.
7
Center for Tropical Medicine, University of Brasília, Brasília, Brazil.
8
Department of Social Medicine, School of Medical Sciences of Santa Casa, São Paulo, Brazil.

Abstract

BACKGROUND:

In March 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10), which was licensed based on non-inferiority of immunological correlates of protection compared with the seven-valent vaccine. The schedule comprised three primary doses at ages 2 months, 4 months, and 6 months, and a booster dose at age 12 months. A single catch-up dose was offered for children aged 12-23 months at the time of introduction. We assessed PCV10 effectiveness against invasive pneumococcal disease in Brazilian children.

METHODS:

Invasive pneumococcal disease, defined as isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid, or another normally sterile site, was identified in children age-eligible for at least one PCV10 dose through laboratory-based and hospital-based surveillance in ten states in Brazil from March 1, 2010, until Dec 31, 2012. We aimed to identify four age-matched and neighbourhood-matched controls for each case. We used conditional logistic regression and calculated PCV10 effectiveness as (1-adjusted matched odds ratio) × 100% for vaccine-type and vaccine-related serotypes (ie, in the same serogroup as a vaccine serotype).

FINDINGS:

In 316 cases (median age 13·2 months, range 2·6-53·1) and 1219 controls (13·3 months, 2·6-53·1), the adjusted effectiveness of an age-appropriate PCV10 schedule was 83·8% (95% CI 65·9-92·3) against vaccine serotypes, and 77·9% (41·0-91·7) against vaccine-related serotypes. Serotype-specific effectiveness was shown for the two most common vaccine serotypes-14 (87·7%, 60·8-96·1) and 6B (82·8%, 23·8-96·1)-and serotype 19A (82·2%, 10·7-96·4), a serotype related to vaccine serotype 19F. A single catch-up dose in children aged 12-23 months was effective against vaccine-type disease (68·0%, 17·6-87·6). No significant effectiveness was shown against non-vaccine serotypes for age-appropriate or catch-up schedules.

INTERPRETATION:

In the routine immunisation programme in Brazil, PCV10 prevents invasive disease caused by vaccine serotypes. PCV10 might provide cross-protection against some vaccine-related serotypes.

FUNDING:

Brazilian Ministry of Health, Pan-American Health Organization, and US Centers for Disease Control and Prevention.

PMID:
24726406
DOI:
10.1016/S2213-2600(14)70060-8
[Indexed for MEDLINE]

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