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Invasive pneumococcal disease and 7-valent pneumococcal conjugate vaccine, the Netherlands.

ABSTRACT: In the Netherlands, the national immunization program includes 7-valent pneumococcal conjugate vaccine (PCV7) for all newborns born after April 1, 2006. We compared the incidence of invasive pneumococcal disease (IPD) and patient and disease characteristics before PCV7 introduction (June 2004-June 2006) with those after PCV7 introduction (June 2008-June 2010). Culture-confirmed IPD cases were identified by 9 sentinel laboratories covering ≈25% of the Dutch population. Significant declines in overall IPD incidence were observed in children <2 (60%) and in persons >65 (13%) years of age. A trend toward gradual increases in non-PCV7 serotype IPD infections was observed in all age groups; the largest increases were among persons 50-64 (37%) and >65 (25%) years of age. In adults, the proportion of immunocompromised persons increased among IPD patients. Overall, deaths from IPD decreased from 16% to 12% because of a lower case-fatality rate for persons with non-PCV7 serotype IPD.

SUBMITTER: van Deursen AM

PROVIDER: S-EPMC3559145 | biostudies-literature | 2012 Nov

REPOSITORIES: biostudies-literature

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Invasive pneumococcal disease and 7-valent pneumococcal conjugate vaccine, the Netherlands.

van Deursen Anna M M AM van Mens Suzan P SP Sanders Elisabeth A M EA Vlaminckx Bart J M BJ de Melker Hester E HE Schouls Leo M LM de Greeff Sabine C SC van der Ende Arie A

Emerging infectious diseases 20121101 11

In the Netherlands, the national immunization program includes 7-valent pneumococcal conjugate vaccine (PCV7) for all newborns born after April 1, 2006. We compared the incidence of invasive pneumococcal disease (IPD) and patient and disease characteristics before PCV7 introduction (June 2004-June 2006) with those after PCV7 introduction (June 2008-June 2010). Culture-confirmed IPD cases were identified by 9 sentinel laboratories covering ≈25% of the Dutch population. Significant declines in ove ...[more]

PMID: 23092683

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Project description:The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in The Netherlands in 2006 and was replaced by PHiD-CV10 in 2011. Data on carriage prevalence of S. pneumoniae serotypes in children and invasive pneumococcal disease (IPD) in children and older adults were collected to examine the impact of PCVs on carriage and IPD in The Netherlands. Pneumococcal carriage prevalence was determined by conventional culture of nasopharyngeal swabs in 24-month-old children in 2015/2016. Data were compared to similar carriage studies in 2005 (pre-PCV7 introduction), 2009, 2010/2011 and 2012/2013. Invasive pneumococcal disease isolates from hospitalized children <5 years and adults >65 years (2004-2016) were obtained by sentinel surveillance. All isolates were serotyped by Quellung. Serotype invasive disease potential was calculated using carriage and nationwide IPD data in children. The overall pneumococcal carriage rate was 48% in 2015/2016, lower than in 2010/2011 (64%) and pre-vaccination in 2005 (66%). Carriage of the previously dominant non-vaccine serotypes 19A and 11A has declined since 2010/2011, from 14.2% to 4.6% and 4.2% to 2.7%, respectively, whereas carriage of serotypes 6C and 23B has increased (4.2% to 6.7% and 3.9% to 7.3%), making serotypes 6C and 23B the most prevalent carriage serotypes. IPD incidence declined in children (20/100,000 cases in 2004/2006 to 6/100,000 cases in 2015/2016) as well as in older adults (63/100,000 cases to 51/100,000 cases). Serotypes 6C, 23B and 11A have high carriage prevalence in children, but show low invasive disease potential. Serotype 8 is the main causative agent for IPD in older adults (11.3%). In conclusion, 10 years after the introduction of pneumococcal vaccination in children in The Netherlands shifts in carriage and disease serotypes are still ongoing. Surveillance of both carriage and IPD is important to assess PCV impact and to predict necessary future vaccination strategies in both children and older adults.

Project description:BackgroundTen-valent pneumococcal conjugate vaccine (PCV10), delivered at 6, 10, and 14 weeks of age was introduced in Kenya in January, 2011, accompanied by a catch-up campaign in Kilifi County for children aged younger than 5 years. Coverage with at least two PCV10 doses in children aged 2-11 months was 80% in 2011 and 84% in 2016; coverage with at least one dose in children aged 12-59 months was 66% in 2011 and 87% in 2016. We aimed to assess PCV10 effect against nasopharyngeal carriage and invasive pneumococcal disease (IPD) in children and adults in Kilifi County.MethodsThis study was done at the KEMRI-Wellcome Trust Research Programme among residents of the Kilifi Health and Demographic Surveillance System, a rural community on the Kenyan coast covering an area of 891 km2. We linked clinical and microbiological surveillance for IPD among admissions of all ages at Kilifi County Hospital, Kenya, which serves the community, to the Kilifi Health and Demographic Surveillance System from 1999 to 2016. We calculated the incidence rate ratio (IRR) comparing the prevaccine (Jan 1, 1999-Dec 31, 2010) and postvaccine (Jan 1, 2012-Dec 31, 2016) eras, adjusted for confounding, and reported percentage reduction in IPD as 1 minus IRR. Annual cross-sectional surveys of nasopharyngeal carriage were done from 2009 to 2016.FindingsSurveillance identified 667 cases of IPD in 3 211 403 person-years of observation. Yearly IPD incidence in children younger than 5 years reduced sharply in 2011 following vaccine introduction and remained low (PCV10-type IPD: 60·8 cases per 100 000 in the prevaccine era vs 3·2 per 100 000 in the postvaccine era [adjusted IRR 0·08, 95% CI 0·03-0·22]; IPD caused by any serotype: 81·6 per 100 000 vs 15·3 per 100 000 [0·32, 0·17-0·60]). PCV10-type IPD also declined in the post-vaccination era in unvaccinated age groups (<2 months [no cases in the postvaccine era], 5-14 years [adjusted IRR 0·26, 95% CI 0·11-0·59], and ≥15 years [0·19, 0·07-0·51]). Incidence of non-PCV10-type IPD did not differ between eras. In children younger than 5 years, PCV10-type carriage declined between eras (age-standardised adjusted prevalence ratio 0·26, 95% CI 0·19-0·35) and non-PCV10-type carriage increased (1·71, 1·47-1·99).InterpretationIntroduction of PCV10 in Kenya, accompanied by a catch-up campaign, resulted in a substantial reduction in PCV10-type IPD in children and adults without significant replacement disease. Although the catch-up campaign is likely to have brought forward the benefits by several years, the study suggests that routine infant PCV10 immunisation programmes will provide substantial direct and indirect protection in low-income settings in tropical Africa.FundingGavi, The Vaccine Alliance and The Wellcome Trust of Great Britain.

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Invasive pneumococcal disease and 7-valent pneumococcal conjugate vaccine, the Netherlands.

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Invasive pneumococcal disease and 7-valent pneumococcal conjugate vaccine, the Netherlands.

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