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Thorax. 2019 May;74(5):473-482. doi: 10.1136/thoraxjnl-2018-211767. Epub 2018 Oct 24.

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination.

Author information

1
EpiConcept, Paris, France.
2
Antwerp University, Antwerp, Belgium.
3
National Institute of Public Health, Prague, Czech Republic.
4
Statens Serum Institut, Copenhagen, Denmark.
5
Public Health England, London, UK.
6
National Institute for Health and Welfare, Helsinki, Finland.
7
University of Tampere, Tampere, Finland.
8
Santé publique France, Saint-Maurice, France.
9
Health Protection Surveillance Centre, Dublin, Ireland.
10
National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
11
Norwegian Institute of Public Health, Oslo, Norway.
12
Public Health Agency of Catalunya, Barcelona, Spain.
13
CIBER Epidemiología y Salud Pública, Madrid, Spain.
14
General Directorate of Public Health, Madrid, Spain.
15
Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.
16
Health Protection Scotland, National Services Scotland, Glasgow, UK.
17
Public Health Agency of Sweden, Solna, Sweden.
18
National Centre for Pneumococci, European Hospital George Pompidou, Paris, France.
19
Irish Pneumococcal Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland.
20
Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, Amsterdam, The Netherlands.
21
Instituto de Recerca Pediátrica, Hospital Sant Joan de Deu, Universitat Internacional de Catalunya, Barcelona, Spain.
22
Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK.
23
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
24
Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
25
European Centre for Disease Prevention and Control, Stockholm, Sweden.

Abstract

BACKGROUND:

Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies.

METHODS:

For each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011-2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 - IRR)*100.

RESULTS:

After five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI -4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI -8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20-29% and 32-53% of IPD cases in PCV13 and PCV10 sites, respectively.

CONCLUSION:

Overall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative.

KEYWORDS:

bacterial infection; clinical epidemiology

PMID:
30355641
PMCID:
PMC6484683
DOI:
10.1136/thoraxjnl-2018-211767
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: The following authors report funding for research projects, travels or consultancy outside the submitted work: H-CS (project sponsored by Pfizer); ZH (travel grant from Pfizer), SNL (research including GSK, Pfizer, Sanofi Pasteur on behalf of St George’s University of London and Public Health England (PHE)); NKF (employed by PHE Respiratory and Vaccine Preventable Bacteria Reference Unit and PHE Immunisation that provided serotype surveillance reports to Affinivax, Pfizer and GSK); HR-K and JJ (employed by the National Institute for Health and Welfare that received research funding from GSK for the conduct of a trial of PCV10); AvdE (Pfizer grant for an investigator initiated project, consultancy fees from GSK, participation in the Pfizer Scientific Advisory board); CM-A (fees from GSK and grants from Pfizer); EV (Pfizer grants and personal fees); MC (Pfizer grants and personal fees); HH (research funding from Pfizer and Astellas).

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