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

Hanquet, G. et al. (2019) Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination. Thorax, 74(5), pp. 473-482. (doi: 10.1136/thoraxjnl-2018-211767) (PMID:30355641) (PMCID:PMC6484683)

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.

• Item Type: Articles
• Additional Information: This study was co-funded by participating countries, the ECDC (SpIDnet project) and the European Commission (Horizon 2020, I-MOVE+).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Smith, Professor Andrew
• Authors: Hanquet, G., Krizova, P., Valentiner-Branth, P., Ladhani, S. N., Nuorti, J. P., Lepoutre, A., Mereckiene, J., Knol, M., Winje, B. A., Ciruela, P., Ordobas, M., Guevara, M., McDonald, E., Morfeldt, E., Kozakova, J., Slotved, H.-C., Fry, N. K., Rinta-Kokko, H., Varon, E., Corcoran, M., van der Ende, A., Vestrheim, D. F., Munoz-Almagro, C., Latasa, P., Castilla, J., Smith, A., Henriques-Normark, B., Whittaker, R., Pastore Celentano, L., and Savulescu, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: Thorax
• Publisher: BMJ Publishing Group
• ISSN: 0040-6376
• ISSN (Online): 1468-3296
• Published Online: 24 October 2018
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Thorax 74(5):473-482
• Publisher Policy: Reproduced under a Creative Commons License