Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance

Abstract

SUMMARY Background In 2000, 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in the U.S. and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and modest increases in non-PCV7-type IPD. In 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the U.S. immunization schedule. We evaluated the effect of PCV13 use in children on IPD in children and adults in the U.S. Methods We used laboratory- and population-based data on incidence of IPD from CDC’s Emerging Infections Program / Active Bacterial Core surveillance in a time-series model to estimate the impact of vaccination. Cases of IPD during July 2004–June 2013 were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13/nonPCV7). Findings Compared with incidence expected among children <5 years old if PCV7 alone had been continued, incidence of IPD overall and IPD caused by PCV13/nonPCV7 serotypes declined by 64% (95% interval estimate [IE] 59–68 %) and 93% (95%IE 91–94), respectively, by July 2012–June 2013. Among adults, incidence of IPD overall and PCV13/nonPCV7-type IPD also declined by 12–32% and 58–72%, respectively, depending on age. In all age groups, reductions were driven principally by changes in incidence of serotypes 19A and 7F. We estimate that over 30,000 cases of IPD and 3,000 deaths were averted in the first 3 years following PCV13 introduction. Interpretation PCV13 has reduced IPD among all ages when used routinely in children in the U.S. Serotypes 19A and 7F, which emerged after PCV7 introduction, have been effectively controlled.

Pneumococcal serotype distribution: A snapshot of recent data in pediatric and adult populations around the world

“…Among the most prevalent serotypes, 5 studies reported 22F ( 6.0%) 6,24,57,60,61 and 4 studies reported 11A ( 14.0%). 24,[61][62][63] Further, among the 4 studies reporting IPD-related pneumococcal illness, 6,24,57,58 serotypes 8 (range: 1.6-3.8%) and 12F (1.9-5.9%) were reported in all of them and 9N (3.8% and 4.2%) 6,58 and 10A (1.9% and 1.0%) 6,58 were reported in 2 studies. For non-IPD related carriage or illness, the most prevalent serotype was 11A in all 3 studies.…”

“…31,33,40,41,44 Prevalence of serotypes uniquely covered by PPV23 was reported in a total of 33 papers. Most often ranking in the top 3 among those serotypes in PPV23 but not in PCV13 for IPDrelated pneumococcal illness were serotypes 15B (or 15B/C) reported in 9 papers 6,[8][9][10]15,17,20,24,26 at up to 11.8% prevalent, 26 5 papers reporting serotype 22F ( 11.3%) 15 Prevalence of serotypes not covered by any pneumococcal vaccines (i.e., PCV13 or PPV23) was reported in a total of 34 papers. Most often ranking in the top 3 among nonvaccine serotypes in IPD-related pneumococcal illness were serotypes 15A reported in 4 papers at up to 6.5% prevalent, 8 15,17 and non-IPD (1.2-5.6%), 43,45,48 cases.…”

“…There were 9 studies reporting serotype distribution data among adults aged 65 y and older with IPD 5,6,18,24,[55][56][57][58][59] and another 3 with similar data on non-IPD conditions (Table 2). [60][61][62] Conjugate vaccine serotypes (i.e., serotypes included in PCV13) causing IPD among older adults were highly prevalent (> 60% of serotypes) in only 2 studies, one Polish 6 and one Spanish.…”

“…[60][61][62] Prevalence of serotypes 15B (1.0-2.6%) and 10A (1.8-4.0%) were also noteworthy. 60,62 Prevalence of serotypes not covered by any pneumococcal vaccines was reported in only 2 IPD studies, which reported serotypes 38 (5.2%) 58 and 6C (2.7%) 24 to be the most prevalent. Three non-IPD related carriage or illness studies, reported serotypes 15A (9.6%), 62 34 (6.1%) 60 and 6C (6.0%) 61 to be the most prevalent.…”

Lessons learned from making and implementing vaccine recommendations in the U.S.

“…After ACIP recommended universal vaccination of children aged <2 years with 7-valent pneumococcal conjugate vaccine (PCV7) beginning in 2000, replaced by a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010, 23 the U.S. and other countries experienced corresponding dramatic declines in invasive pneumococcal disease (IPD) caused by vaccine strains in vaccinated children. 24 However, the nationwide implementation of vaccine recommendations also significantly decreased the incidence of IPD among U.S. adults aged ≥65 years. 25 Streptococcus pneumoniae infections by serotypes in PCV13 in adults aged ≥65 years declined approximately 50% beginning in 2010 (when PCV13 replaced PCV7 in the routine childhood immunization schedule).…”