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Am J Epidemiol. 2019 Jan 1;188(1):160-168. doi: 10.1093/aje/kwy219.

Association Between the Decline in Pneumococcal Disease in Unimmunized Adults and Vaccine-Derived Protection Against Colonization in Toddlers and Preschool-Aged Children.

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Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Infection Prevention and Control Unit, Sheba Medical Center, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatric Infectious Diseases Unit, Soroka University Medical Center, Be'er Sheva, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.


Vaccinating children with pneumococcal conjugate vaccine (PCV) disrupts transmission, reducing disease rates in unvaccinated adults. When considering changes in vaccine dosing strategies (e.g., removing doses), it is critical to understand which groups of children contribute most to transmission to adults. We used data from Israel (2009-2016) to evaluate how the buildup of vaccine-associated immunity in children was associated with declines in invasive pneumococcal disease (IPD) due to vaccine-targeted serotypes in unimmunized adults. Data on vaccine uptake and prevalence of colonization with PCV-targeted serotypes were obtained from children visiting an emergency department in southern Israel and from surveys of colonization from central Israel. Data on IPD in adults were obtained from a nationwide surveillance study carried out in Israel. We compared the trajectory of decline of IPD due to PCV-targeted serotypes in adults with the decline of colonization prevalence and increase in vaccine-derived protection against pneumococcal carriage among different age groupings of children. The declines in IPD in adults were most closely associated with the declines in colonization and increased vaccination coverage among children in the age range of 36-59 months. This suggests that preschool-aged children, rather than infants, are responsible for maintaining the indirect benefits of PCVs.

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