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Clin Infect Dis. 2017 Jan 15;64(2):175-183. doi: 10.1093/cid/ciw720. Epub 2016 Oct 21.

Long-term Impact of a "3 + 0" Schedule for 7- and 13-Valent Pneumococcal Conjugate Vaccines on Invasive Pneumococcal Disease in Australia, 2002-2014.

Author information

1
National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead; sanjay.jayasinghe@health.nsw.gov.au.
2
Discipline of Child and Adolescent Health, University of Sydney, and.
3
School of Public Health and Community Medicine, University of New South Wales, Sydney.
4
National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead.
5
Office of Health Protection, Australian Government Department of Health, Canberra.
6
Department of Infectious Diseases and Microbiology, Princess Margaret Hospital, School of Paediatrics and Child Health and Telethon Kids Institute, University of Western Australia, Perth.
7
Centre for Disease Control, Department of Health, Darwin, Northern Territory; and.
8
School of Public Health, University of Sydney, Sydney, Australia.

Abstract

BACKGROUND:

Australia introduced universal 7-valent pneumococcal conjugate vaccine (PCV7) from 2005, replaced by 13-valent PCV (PCV13) in 2011, uniquely among high-income countries giving doses at 2, 4, and 6 months (3 + 0 schedule). Data on impact of a timely 3 + 0 PCV schedule with high coverage are sparse, with none for PCV13.

METHODS:

We used national surveillance of invasive pneumococcal disease (IPD) from 2002 for baseline and appropriate later comparison periods to calculate incidence rate ratios (IRRs) by serotype and age using a Poisson model. PCV coverage was assessed from the Australian Childhood Immunisation Register.

RESULTS:

After 9 years of timely 3-dose PCV coverage of >92%, all-age IPD in Australia almost halved (IRR, 0.53; 95% confidence interval [CI], .50-.57), but differed by PCV era. Reductions in IPD due to vaccine serotypes from PCV7 (IRR, 0.20; CI, .17-.22) were about 2-fold greater than for IPD due to extra serotypes in PCV13 (13v-non7v) in a similar period (IRR, 0.58; CI, .51-.66). Post-PCV13 declines in serotype 19A IPD in persons aged <2 years (IRR, 0.23; CI, .13-.35) and ≥2 years (IRR, 0.35; CI, .28-.44) differed from other 13v-non7v IPD (IRR, 0.73; CI, .35-1.48 for those aged <2 years and IRR, 0.96; CI, .81-1.15 for those ≥2 years). Meningitis due to vaccine serotypes nearly disappeared in children eligible for 3 PCV13 doses. IPD due to non-PCV13 serotypes increased by 30% compared with 76% for non-PCV7 serotypes in equivalent period of vaccine use.

CONCLUSIONS:

Reductions in vaccine-type IPD post-PCV13 were inferior to Australian experience with PCV7 and reports from high-income countries giving a PCV booster dose. Applicability of findings to other settings would depend on age of IPD onset, serotype profile, and timeliness of vaccination.

KEYWORDS:

Australia; PCV13; PCV7; invasive pneumococcal disease; vaccine impact.

PMID:
27986682
DOI:
10.1093/cid/ciw720
[Indexed for MEDLINE]

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