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Multicenter Study
. 2019 May;74(5):473-482.
doi: 10.1136/thoraxjnl-2018-211767. Epub 2018 Oct 24.

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination

Germaine Hanquet  1   2 , Pavla Krizova  3 , Palle Valentiner-Branth  4 , Shamez N Ladhani  5 , J Pekka Nuorti  6   7 , Agnes Lepoutre  8 , Jolita Mereckiene  9 , Mirjam Knol  10 , Brita A Winje  11 , Pilar Ciruela  12   13 , Maria Ordobas  14 , Marcela Guevara  13   15 , Eisin McDonald  16 , Eva Morfeldt  17 , Jana Kozakova  3 , Hans-Christian Slotved  4 , Norman K Fry  5 , Hanna Rinta-Kokko  6 , Emmanuelle Varon  18 , Mary Corcoran  19 , Arie van der Ende  20 , Didrik F Vestrheim  11 , Carmen Munoz-Almagro  13   21 , Pello Latasa  14 , Jesus Castilla  13   15 , Andrew Smith  22 , Birgitta Henriques-Normark  17   23   24 , Robert Whittaker  25 , Lucia Pastore Celentano  25 , Camelia Savulescu  1 ; SpIDnet/I-MOVE+ Pneumo Group
Collaborators, Affiliations
Multicenter Study

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination

Germaine Hanquet et al. Thorax. 2019 May.

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.

Keywords: bacterial infection; clinical epidemiology.

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Conflict of interest statement

Competing interests: The following authors report funding for research projects, travels or consultancy outside the submitted work: H-CS (project sponsored by Pfizer); ZH (travel grant from Pfizer), SNL (research including GSK, Pfizer, Sanofi Pasteur on behalf of St George’s University of London and Public Health England (PHE)); NKF (employed by PHE Respiratory and Vaccine Preventable Bacteria Reference Unit and PHE Immunisation that provided serotype surveillance reports to Affinivax, Pfizer and GSK); HR-K and JJ (employed by the National Institute for Health and Welfare that received research funding from GSK for the conduct of a trial of PCV10); AvdE (Pfizer grant for an investigator initiated project, consultancy fees from GSK, participation in the Pfizer Scientific Advisory board); CM-A (fees from GSK and grants from Pfizer); EV (Pfizer grants and personal fees); MC (Pfizer grants and personal fees); HH (research funding from Pfizer and Astellas).

Figures

Figure 1
Figure 1
Overall incidence of invasive pneumococcal disease per site and years in persons aged ≥65 years over the period 2000–2015: SpIDnet/I-MOVE+ multicentre study.
Figure 2
Figure 2
Site incidence rate ratio by serotype category in 2015 compared with 2009: SpIDnet/I-MOVE+ multicentre study. (A) All. (B) PCV7. (C) Included in PCV10 and not in PCV7 (1, 5 and 7F). (D) Included in PCV13 and not in PCV10 (3, 6A and 19A). (E) Non-PCV13. (F) PPV23 non-PCV13. (G) Non-vaccine.
Figure 3
Figure 3
Pooled incidence rate ratio per serotype group over the PCV10/13 years (2011–2015) compared with 2009: SpIDnet/I-MOVE+ multicentre study.
Figure 4
Figure 4
Pooled incidence rate ratio per serotype group over the PCV10/13 years compared with 2009 by vaccine policy: SpIDnet/I-MOVE+ multicentre study.
Figure 5
Figure 5
Proportion of serotypes out of all invasive pneumococcal disease in 2015 by serotype group, site and vaccination policies: SpIDnet/I-MOVE+ multicentre study.
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