TY - JOUR
T1 - Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites
AU - Feikin, Daniel R.
AU - Kagucia, Eunice W.
AU - Loo, Jennifer D.
AU - Link-Gelles, Ruth
AU - Puhan, Milo A.
AU - Cherian, Thomas
AU - Levine, Orin S.
AU - Whitney, Cynthia G.
AU - O'Brien, Katherine L.
AU - Moore, Matthew R.
AU - AUTHOR GROUP
AU - Adegbola, Claire A.
AU - Agocs, Mary
AU - Ampofo, Krow
AU - Andrews, Nick
AU - Barton, Theresa
AU - Benito, Javier
AU - Broome, Claire V.
AU - Bruce, Michael G.
AU - Bulkow, Lisa R.
AU - Byington, Carrie L.
AU - Camou, Teresa
AU - Cook, Heather
AU - Cotter, Suzanne
AU - Dagan, Ron
AU - de Wals, Philippe
AU - Deceuninck, Geneviève
AU - Denham, Barbara
AU - Edwards, Giles
AU - Eskola, Juhani
AU - Fitzgerald, Margaret
AU - Galanakis, Emmanouil
AU - Garcia-Gabarrot, Gabriela
AU - Garcia-Garcia, Juan J.
AU - Gene, Amadeu
AU - Gomez, Borja
AU - Heffernan, Helen
AU - Hennessy, Thomas W.
AU - Heuberger, Sigrid
AU - Hilty, Markus
AU - Ingels, Helene
AU - Jayasinghe, Sanjay
AU - Kellner, James D.
AU - Klein, Nicola P.
AU - Kormann-Klement, Andrea
AU - Kozakova, Jana
AU - Krause, Vicki
AU - Kriz, Paula
AU - Lambertsen, Lotte
AU - Spanjaard, Lodewijk
AU - van der Ende, Arie
PY - 2013
Y1 - 2013
N2 - Background: Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccineserotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction. Methods and Findings: Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data >= 2 years before and >= 1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children,5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0.55, 95% CI 0.46-0.65) and remained relatively stable through year 7 (RR 0.49, 95% CI 0.35-0.68). Point estimates for VT IPD decreased annually through year 7 (RR 0? 03, 95% CI 0.01-0.10), while NVT IPD increased (year 7 RR 2.81, 95% CI 2.12-3.71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0.52, 95% CI 0.29-0.91], 50-64 year-olds [RR 0.84, 95% CI 0.77-0.93], and >= 65 year-olds [RR 0.74, 95% CI 0.58-0.95]). Conclusions: Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used
AB - Background: Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccineserotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction. Methods and Findings: Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data >= 2 years before and >= 1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children,5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0.55, 95% CI 0.46-0.65) and remained relatively stable through year 7 (RR 0.49, 95% CI 0.35-0.68). Point estimates for VT IPD decreased annually through year 7 (RR 0? 03, 95% CI 0.01-0.10), while NVT IPD increased (year 7 RR 2.81, 95% CI 2.12-3.71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0.52, 95% CI 0.29-0.91], 50-64 year-olds [RR 0.84, 95% CI 0.77-0.93], and >= 65 year-olds [RR 0.74, 95% CI 0.58-0.95]). Conclusions: Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used
U2 - https://doi.org/10.1371/journal.pmed.1001517
DO - https://doi.org/10.1371/journal.pmed.1001517
M3 - Article
C2 - 24086113
SN - 1549-1277
VL - 10
SP - e1001517
JO - PLoS medicine
JF - PLoS medicine
IS - 9
ER -