TY - JOUR
T1 - Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries
T2 - implications for adult vaccination
AU - Hanquet, Germaine
AU - Krizova, Pavla
AU - Valentiner-Branth, Palle
AU - Ladhani, Shamez N
AU - Nuorti, J Pekka
AU - Lepoutre, Agnes
AU - Mereckiene, Jolita
AU - Knol, Mirjam
AU - Winje, Brita A
AU - Ciruela, Pilar
AU - Ordobas, Maria
AU - Guevara, Marcela
AU - McDonald, Eisin
AU - Morfeldt, Eva
AU - Kozakova, Jana
AU - Slotved, Hans-Christian
AU - Fry, Norman K
AU - Rinta-Kokko, Hanna
AU - Varon, Emmanuelle
AU - Corcoran, Mary
AU - van der Ende, Arie
AU - Vestrheim, Didrik F
AU - Munoz-Almagro, Carmen
AU - Latasa, Pello
AU - Castilla, Jesus
AU - Smith, Andrew
AU - Henriques-Normark, Birgitta
AU - Whittaker, Robert
AU - Pastore Celentano, Lucia
AU - Savulescu, Camelia
AU - SpIDnet/I-MOVE+ Pneumo Group
AU - Harboe, ZItta Barrella
N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
KW - Aged
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Incidence
KW - Male
KW - Pneumococcal Vaccines/pharmacology
KW - Retrospective Studies
KW - Serogroup
KW - Streptococcus pneumoniae/immunology
KW - Vaccination/methods
U2 - 10.1136/thoraxjnl-2018-211767
DO - 10.1136/thoraxjnl-2018-211767
M3 - Journal article
C2 - 30355641
SN - 0040-6376
VL - 74
SP - 473
EP - 482
JO - Thorax
JF - Thorax
IS - 5
ER -