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Hanquet G, Krizova P, Valentiner-Branth P, Ladhani SN, Nuorti JP, Lepoutre A, Mereckiene J, Knol M, Winje BA, Ciruela P, Ordobas M, Guevara M, McDonald E, Morfeldt E, Kozakova J, Slotved HC, Fry NK, Rinta-Kokko H, Varon E, Corcoran M, van der Ende A, Vestrheim DF, Munoz-Almagro C, Latasa P, Castilla J, Smith A, Henriques-Normark B, Whittaker R, Pastore Celentano L, Savulescu C. Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination. Thorax 2018; 74:473-482. [PMID: 30355641 PMCID: PMC6484683 DOI: 10.1136/thoraxjnl-2018-211767] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/31/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
| | - Pavla Krizova
- National Institute of Public Health, Prague, Czech Republic
| | | | | | - J Pekka Nuorti
- National Institute for Health and Welfare, Helsinki, Finland.,University of Tampere, Tampere, Finland
| | | | | | - Mirjam Knol
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Pilar Ciruela
- Public Health Agency of Catalunya, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Marcela Guevara
- CIBER Epidemiología y Salud Pública, Madrid, Spain.,Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - Eisin McDonald
- Health Protection Scotland, National Services Scotland, Glasgow, UK
| | | | - Jana Kozakova
- National Institute of Public Health, Prague, Czech Republic
| | | | | | | | - Emmanuelle Varon
- National Centre for Pneumococci, European Hospital George Pompidou, Paris, France
| | - Mary Corcoran
- Irish Pneumococcal Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | - Arie van der Ende
- Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Carmen Munoz-Almagro
- CIBER Epidemiología y Salud Pública, Madrid, Spain.,Instituto de Recerca Pediátrica, Hospital Sant Joan de Deu, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pello Latasa
- General Directorate of Public Health, Madrid, Spain
| | - Jesus Castilla
- CIBER Epidemiología y Salud Pública, Madrid, Spain.,Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - Andrew Smith
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK
| | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden.,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Whittaker
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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