Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease After Introduction Into Routine Pediatric Use

Roger Baxter, Laurie Aukes, Stephen I Pelton, Arnold Yee, Nicola P Klein, William C Gruber, Daniel A Scott, Kimberly J Center, Roger Baxter, Laurie Aukes, Stephen I Pelton, Arnold Yee, Nicola P Klein, William C Gruber, Daniel A Scott, Kimberly J Center

Abstract

Background: In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced 7-valent PCV (PCV7) for protection against invasive pneumococcal disease (IPD). This study used laboratory surveillance data to examine the effect of PCV13 on IPD before and after PCV13 introduction among children aged 6 weeks to <6 years and those aged ≥6 weeks.

Methods: Observational laboratory-based IPD surveillance data were compared for the periods May 2010-April 2018 and May 2008-April 2010 (the PCV7 period) using a database of Kaiser Permanente Northern California (KPNC) members with laboratory-confirmed IPD.

Results: Among children aged 6 weeks to 6 years, overall IPD incidence decreased from 11.57 per 100 000 during the PCV7 period to 4.09 per 100 000 after PCV13 introduction; PCV13-type IPD incidence decreased from 5.12 to 0.84 per 100 000. Non-PCV13-serotype IPD did not change significantly in this age group (PCV7 period, 1.71 per 100 000 and after PCV13, 2.52 per 100 000). Of cases occurring in this group, bacteremia was the most common clinical diagnosis. Across all ages, IPD decreased from 9.49 to 6.23 per 100 000 and PCV13-type IPD decreased from 4.67 to 1.89 per 100 000, changes being mostly due to decreases in serotypes 19A and 7F. IPD caused by non-PCV13 serotypes did not change (3.34 and 3.35 per 100 000). Overall, pneumococci isolated after PCV13 introduction had increased susceptibility to penicillin, cefotaxime, and ceftriaxone.This prospective, laboratory-based surveillance study in Kaiser Permanente Northern California members examined annual IPD incidence before and after PCV13 introduction. In children aged 6 weeks to <6 years, IPD caused by PCV13 serotypes decreased significantly (84%) during the surveillance period.

Conclusions: IPD incidence decreased further in every age group after PCV13 introduction, suggesting both direct vaccination effects in the infant population and indirect effects in adults.

Clinical trials registration: NCT01128439.

Keywords: Streptococcus pneumoniae; all ages; PCV13; invasive pneumococcal disease.

© The Author(s) 2020. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society.

Figures

Figure 1.
Figure 1.
PCV coverage by age and year at Kaiser Permanente Northern California (includes 1 or more doses of either PCV7 or PCV13 during the study period). PCV use included only PCV7 from May 2008 through April 2010, either PCV7 or PCV13 during the introductory period (May 2010–April 2011), and only PCV13 thereafter (May 2011–April 2018). Vertical dashed lines indicate dates for PCV13 licensure and recommendations. Note that the increase in coverage among individuals aged 6 to

Figure 2.

Annual IPD incidence per 100…

Figure 2.

Annual IPD incidence per 100 000 by year and age group at Kaiser…

Figure 2.
Annual IPD incidence per 100 000 by year and age group at Kaiser Permanente Northern California. (A) Age 6 weeks to <50 years and (B) age ≥50 years. *Significant difference in IPD incidence begins with PCV13 introduction in May 2010 for children aged ≥6 weeks to <6 years. Abbreviations: IPD, invasive pneumococcal disease; PCV, pneumococcal conjugate vaccine.
Figure 2.
Figure 2.
Annual IPD incidence per 100 000 by year and age group at Kaiser Permanente Northern California. (A) Age 6 weeks to <50 years and (B) age ≥50 years. *Significant difference in IPD incidence begins with PCV13 introduction in May 2010 for children aged ≥6 weeks to <6 years. Abbreviations: IPD, invasive pneumococcal disease; PCV, pneumococcal conjugate vaccine.

References

    1. World Health Organization. 23-valent pneumococcal polysaccharide vaccine WHO position paper. Wkly Epidemiol Rec 2008; 83: 373–84.
    1. Centers for Disease Control and Prevention. Invasive pneumococcal disease in children 5 years after conjugate vaccine introduction— eight states, 1998–2005. MMWR Morb Mortal Wkly Rep 2008; 57:144–8.
    1. Poehling KA, Talbot TR, Griffin MR, et al. . Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA 2006; 295:1668–74.
    1. Centers for Disease Control and Prevention. Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease— United States, 1998–2003. MMWR Morb Mortal Wkly Rep 2005; 54:893–7.
    1. Centers for Disease Control and Prevention. Licensure of a 13-valent pneumococcal conjugate vaccine (PCV13) and recommendations for use among children— Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep 2010; 59:258–61.
    1. Prevnar 13® (pneumococcal 13-valent conjugate vaccine [diphtheria CRM197 protein]). Full Prescribing Information. Collegeville, PA: Pfizer Inc; 2016.
    1. Advisory Committee on Immunization Practices. Preventing pneumococcal disease among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2000; 49:1–35.
    1. Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6–18 years with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2013; 62:521–4.
    1. Centers for Disease Control and Prevention. Licensure of 13-valent pneumococcal conjugate vaccine for adults aged 50 years and older. MMWR Morb Mortal Wkly Rep 2012; 61:394–5.
    1. Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816–9.
    1. Tomczyk S, Bennett NM, Stoecker C, et al. ; Centers for Disease Control and Prevention . Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014; 63:822–5.
    1. World Health Organization. Pneumococcal vaccines WHO position paper— 2012. Wkly Epidemiol Rec 2012; 87:129–44.
    1. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; 19th Informational Supplement. CLSI document M100-19. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
    1. Bennett NM, Whitney CG, Moore M, et al. . Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816–9.
    1. Nuorti JP, Whitney CG; Centers for Disease Control and Prevention . Prevention of pneumococcal disease among infants and children— use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine— recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1–18.
    1. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997; 46:1–24.
    1. Kobayashi M, Bennett NM, Gierke R, et al. . Intervals between PCV13 and PPSV23 vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2015; 64:944–7.
    1. Cooper D, Yu X, Sidhu M, et al. . The 13-valent pneumococcal conjugate vaccine (PCV13) elicits cross-functional opsonophagocytic killing responses in humans to Streptococcus pneumoniae serotypes 6C and 7A. Vaccine 2011; 29:7207–11.
    1. Grant LR, O’Brien SE, Burbidge P, et al. . Comparative immunogenicity of 7 and 13-valent pneumococcal conjugate vaccines and the development of functional antibodies to cross-reactive serotypes. PLoS One 2013; 8:e74906.
    1. Park IH, Pritchard DG, Cartee R, et al. . Discovery of a new capsular serotype (6C) within serogroup 6 of Streptococcus pneumoniae. J Clin Microbiol 2007; 45:1225–33.
    1. Lin J, Kaltoft MS, Brandao AP, et al. . Validation of a multiplex pneumococcal serotyping assay with clinical samples. J Clin Microbiol 2006; 44:383–8.
    1. Paul L. Influenza and pneumococcal disease can be serious, health officials urge vaccination. Available at: Accessed January 13, 2020.
    1. McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev 2006; 19:571–82.
    1. Klugman KP, Chien YW, Madhi SA. Pneumococcal pneumonia and influenza: a deadly combination. Vaccine 2009; 27 Suppl 3:C9–C14.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe