Invasive pneumococcal diseases in children and adults before and after introduction of the 10-valent pneumococcal conjugate vaccine into the Austrian national immunization program

Abstract

BackgroundIn February 2012 the ten-valent pneumococcal conjugate vaccine (PCV10) with a 2+1 doses schedule (3, 5, 12 or 14 months of age) without catch-up vaccination was introduced in Austria. We assessed direct and indirect vaccine effects on invasive pneumococcal disease (IPD) by a population-based intervention study.MethodsThe study period was divided into pre- (2009–2011) and post-period (2013–2017, February), regarding 2012 as transition year. Outcomes were defined as PCV10 ST-IPD, the PCV10-related ST 6A and 19A IPD and non-PCV10 excluding ST 6A-/19A-IPD (NVT-IPD). We used national surveillance data and compared average monthly incidence rate (IR) between pre- and post-period among <5, 5–49 and ≥50 years old. Additionally, for the 5–49 and ≥50 years old, and the 50–59 and ≥60 years old, we analyzed monthly incidence data of the pre-, post-period, and estimated trend and level changes by using a segmented time-series regression.ResultsThe PCV-10 IPD was reduced by 58% (95% CI: 30%; 74%) and 67% (95% CI: 32%; 84%) among <5 and ≥50 years old; the reduction in ≥60 years was 71% (95% CI: 36%; 88%). There were no significant changes in the pre-post-rate or incidence trend of NVT-IPD in the <5 and ≥50 years old. ST-specific analyses revealed no ST 6A- and ST 19A IPD decline in any age-group, and a ST 8 IPD increase among ≥50 years old (IR ratio: 3.5; 95% CI: 1.7; 7.2). We found no vaccine effects among 5–49 years old.ConclusionsOur study adds to the evidence on direct and indirect protection of a childhood PCV10 vaccine program. Elderlies seem to benefit the most. Findings did not support PCV 10 cross-protection, but indicate replacement at least for ST 8 among the ≥50 years old. Follow-up analyses of IPD surveillance data are needed to fully characterize the magnitude of serotype replacement and further vaccine-attributable IPD reduction with time.

Why Infants Rarely Die of COVID-19 and Morbidity and Mortality Rates Vary by Location: Pneumococcal and Hib Vaccinations as Possible Means to Mitigate Future Pandemics

“…Because the more broadly vaccinations are implemented, the stronger both individual immunity and herd immunity becomes, the greater the benefits for everyone. Indeed, every study that has been done of the economic impact of pneumococcal and Hib vaccination programs has shown that for every billion dollars invested in vaccination, several billions are saved in critical care costs for elderly and atrisk patients (Wateska, et al, 2020;Richter, et al, 2019;Zhang, et al, 2018;Ciruela, et al, 2018;Baldo, et al, 2016;Arencibia Jiménez, et al, 2014;Isaacman, et al, 2008 ). Actual savings may be significantly greater since these economic studies have not included the benefits that may accrue from protection against the global economic devastation that a coronavirus or influenza pandemic can cause by shutting down businesses and harming trade.…”

“…The data presented in TABLE 1 suggest that countries with high COVID-19 death rates tend to have low childhood vaccination rates for pneumococci. Hib and pneumococcal vaccines are strong determinants of herd immunity protecting at-risk adults and the elderly from pneumonia risk (Lexau, et al, 2005;Isaacman, et al, 2008;Pletz, et al, 2016;Richter, et al, 2019;Wiese, et al, 2019). In a few countries, high levels of infant vaccination with PCV-13 seem to balance out low levels of adult vaccination, as exemplified by the case of the Netherlands and Switzerland (TABLE 1).…”

“…* Gervaix, et al, 2014;^ Mereckiene, 2017;+ WHO, 2020;> Blank, et al, 2018; # estimated from accumulated yearly vaccinations. Austria (Richter, et al, 2019); France (Contou, et al, 2020); Germany (Theidel, et al, 2013;Pletz, et al, 2016); Greece (Maraki, et al, 2018);US (FluVaxView;Wateska, et al, 2020;Zhang, et al, 2018;Sings, 2017;Williams, et al, 2016); UK (Tolman, et al, 2016); Australia (Hull, et al, 2019;Yang, et al, 2019;Dyda, et al, 2016); Japan (Naito, et al, 2020;Takeda, et al, 2019;Shibata, et al, 2019;Kajikawa, et al, 2019;Kumar, et al, 2014); S. Korea (Song, et al, 2013;Yang, et al, 2015;Park, et al, 2019;Yang, et al, 2020); Italy (Giammanco, et al, 2018;Baldo, et al, 2016;Tozzi, et al, 2014;Fedson, 2011); Spain (Ciruela, et al, 2018;Arencibia Jiménez, et al, 2014;Fedson, 2011); Canada (Kaplan, et al, 2019;Farmanara, et al, 2018); Portugal (Kislaya, et al, 2019); Netherlands (Vestjens, et al, 2019); Switzerland ** NB no current data available (Büla, et al, 1996). (TABLE 1).…”

Aktuelles zur Meningokokken- und Pneumokokken-Impfung

“…Eine Metaanalyse zeigt anhand von Daten aus den USA, Europa und Australien, dass die IPD der im Impfstoff enthaltenen Serotypen bei Erwachsenen nach Einführung des 7-valenten Pneumokokkenimpfstoffes (PCV7) durchschnittlich um 90 % gesunken sind [21]. Der Rückgang der Inzidenz der im Impfstoff enthaltenen Serogruppen bezieht sich sowohl auf geimpfte als auch ungeimpfte Personen und ist auch bei PCV10 und PCV13 in ähnlicher Weise zu beobachten [21][22][23].…”

“…Relativ rasch nach Einführung des PCV7 war allerdings ein Replacement durch nicht im Impfstoff enthaltene Serotypen zu beobachten [24,25]. Durch diese Serotypen werden aktuell vermehrt IPDs verursacht, wie bereits erwähnt [18,23,26,27].…”