Pneumococcal Meningitis Vaccine Breakthroughs and Failures After Routine 7-Valent and 13-Valent Pneumococcal Conjugate Vaccination in Children in France

Godot, Cécile; Lévy, Corinne; Varon, Emmanuelle; Pïcard, Capucine; Madhi, Fouad; Cohen, Robert

doi:10.1097/inf.0000000000000818

Cited by 23 publications

(24 citation statements)

References 10 publications

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“…For this serotype the expected cross-protection from PCV7 because of the inclusion of the serogroup 19 by serotype 19F was limited and a delayed effect of the vaccine on this intrinsically more epidemic serotype, which was still in full expansion when the vaccine was introduced, was also reported in other countries [6, 28]. In the last few years, a resurgence of PCV7-serotype 19F was also observed, making it the most frequent serotype responsible for PCV7 failure in France [29]. This penicillin-resistant serotype might have been driven by high antibiotic exposure and vaccine-induced antibodies weaker than for the remaining serotypes [30].…”

Section: Discussionmentioning

confidence: 97%

Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis

Alari

Chaussade

Cellès

et al. 2016

BMC Med

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BackgroundPneumococcal meningitis (PM) is a major invasive pneumococcal disease. Two pneumococcal conjugate vaccines (PCVs) have been introduced in France: PCV7 was recommended in 2003 and replaced in 2010 by PCV13, which has six additional serotypes. The impact of introducing those vaccines on the evolution of PM case numbers and serotype distributions in France from 2001 to 2014 is assessed herein.MethodsData on 5166 Streptococcus pneumoniae strains isolated from cerebrospinal fluid between 2001 and 2014 in the 22 regions of France were obtained from the National Reference Center for Pneumococci. The effects of the different vaccination campaigns were estimated using time series analyses through autoregressive moving-average models with exogenous variables (“flu-like” syndromes incidence) and intervention functions. Intervention functions used 11 dummy variables representing each post vaccine epidemiological period. The evolution of serotype distributions was assessed for the entire population and the two most exposed age groups (<5 and > 64 years old).ResultsFor the first time since PCV7 introduction in 2003, total PM cases decreased significantly after starting PCV13 use: –7.1 (95% CI, –10.85 to –3.35) cases per month during 2013–2014, and was confirmed in children < 5 years old (–3.5; 95% CI, –4.81 to –2.13) and adults > 64 years old (–2.0; 95% CI, –3.36 to –0.57). During 2012–2014, different non-vaccine serotypes emerged: 12F, 24F in the entire population and children, 6C in the elderly; serotypes 3 and 19F persisted in the entire population.ConclusionsUnlike other European countries, the total PM cases in France declined only after introduction of PCV13. This suggests that vaccine pressure alone does not explain pneumococcal epidemiological changes and that other factors could play a role. Serotype distribution had changed substantially compared to the pre-vaccine era, as in other European countries, but very differently from the US. A highly reactive surveillance system is thus necessary not only to monitor evolutions due to vaccine pressure and to verify the local serotypic appropriateness of new higher-valent pneumococcal vaccines, but also to recognise and prevent unexpected changes due to other internal or external factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0755-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 97%

Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis

Alari

Chaussade

Cellès

et al. 2016

BMC Med

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“…14,15 To determine the impact of the PCVs in France, several surveillance systems of pneumococcal infection and carriage were established before and after PCV implementation. 11,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] All these studies were approved by the French National Data Protection Commission (CNIL) and/or the French Ethics Committee. Most of the studies were requested by the European Agency for the Evaluation of Medicinal Products as a post-licensing commitment.…”

Section: 3mentioning

confidence: 99%

The multifaceted impact of pneumococcal conjugate vaccine implementation in children in France between 2001 to 2014

Cohen

Biscardi

Lévy

2016

Human Vaccines & Immunotherapeutics

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In 2003, France was the first European country to recommend 7-valent pneumococcal conjugate vaccine (PCV7) for a large proportion of healthy children. With complicated recommendations, the vaccine coverage during the first 4 y of implementation was low, then progressively increased to reach 90% in 2008. The aim of this review was to describe the particular impact of PCVs in a country where the vaccine coverage was initially suboptimal.After PCV7 implementation, the PCV7 serotypes nearly disappeared among pneumococci isolated from meningitis (¡73%), other invasive pneumococcal disease (IPD; ¡90%) and pneumococcal carriage (¡97%). Consequently, the rates of penicillin-resistant strains declined. However, because of important serotype replacement, the global effect on the incidence of meningitis (¡31%) or other IPD (¡14%) was modest and observed only in young children < 2 y old. After PCV13 transition, with immediate high vaccine coverage, the vaccine had an important impact on all pneumococcal disease: reduction of ¡20% for pneumococcal meningitis, ¡36% for non-meningitis IPD, ¡32% for community acquired pneumonia and ¡15% for S. pneumoniae carriage.These findings underline the complexity of pneumococcal epidemiology and the importance of high and fast vaccination coverage to obtain the optimal effect of PCVs.

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“…However, two cases of PCV13 failures (due to serotypes 19A and 19F) have been reported by Godot et al : One in a child aged 15.4 months at the time of diagnosis, who had received three PCV13 doses and had no underlying predisposing condition related to his vaccination failure. The second child, aged 57.1 months, had received three doses of PCV7 and a booster dose with PCV13; he, however, had a cochlear implant as the likely underlying condition.…”

Section: Commentsmentioning

confidence: 99%

“…Despite the fact that the benefits of this new vaccine are being universally recognized, some cases of vaccination failures have been reported, mostly in those immune‐compromised and/or in children with underlying predisposing conditions .…”

Section: Introductionmentioning

confidence: 99%

Streptococcus pneumoniae serotype 19A meningitis in well‐vaccinated immunocompetent 13‐month‐old child: a case of PCV13 failure

Kayemba-Kay’s¹,

Badran²,

Lagneaux

et al. 2016

Clinical Case Reports

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Pneumococcal Meningitis Vaccine Breakthroughs and Failures After Routine 7-Valent and 13-Valent Pneumococcal Conjugate Vaccination in Children in France

Cited by 23 publications

References 10 publications

Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis

Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis

The multifaceted impact of pneumococcal conjugate vaccine implementation in children in France between 2001 to 2014

Streptococcus pneumoniae serotype 19A meningitis in well‐vaccinated immunocompetent 13‐month‐old child: a case of PCV13 failure

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