Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: a pooled analysis of multiple surveillance sites
Open accessAbstract
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-vaccine-serotype (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. Please see later in the article for the Editors' Summary.
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A rise in nonvaccine pneumococcal serotypes has to some extent offset the benefits of vaccine introduction.
“Indeed, a rise in nonvaccine serotypes has to some extent offset the benefits of vaccine introduction 9”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [9]
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- Authors
- Feikin, D. R., Kagucia, E. W., Loo, J. D., Link-Gelles, R., Puhan, M. A., Cherian, T., Levine, O. S., Whitney, C. G., O’Brien, K. L., Moore, M. R., & the Serotype Replacement Study Group
- Affiliations
- Centers for Disease Control and Prevention (US)
- Johns Hopkins University (US)
- World Health Organization (CH)
- Corresponding author
- Feikin, Daniel R.
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-09-24
- Volume
- 10
- Issue
- 9
- Pages
- e1001517
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3782411
- OpenAlex
- W2157583453
- Cited by
- 470
- References
- 58
- Citations by year
- 2026: 22 · 2025: 19 · 2024: 26 · 2023: 18 · 2022: 21 · 2021: 35 · 2020: 36 · 2019: 47 · 2018: 56 · 2017: 56 · 2016: 48 · 2015: 49 · 2014: 36
- FWCI
- 32.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (publishedVersion, cc-by)
- Pure Amsterdam UMC (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, public-domain)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- National University of Singapore (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, public-domain)
- Figshare (submittedVersion, cc-by)
- RWTH Publications (RWTH Aachen) (submittedVersion, other-oa)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, public-domain)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Bill and Melinda Gates Foundation (OPP1020720)
- Pfizer
- GlaxoSmithKline
- Sanofi
- Kaiser Permanente
- Public Health Agency of Canada
- Public Health Agency
- Terveyden ja hyvinvoinnin laitos
- Sanofi Pasteur
- Health Canada
- Topics
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
- Keywords
- invasive pneumococcal disease, 7-valent pneumococcal conjugate vaccine, serotype replacement, non-vaccine serotypes, vaccine serotypes, vaccine impact, children under five, adults, Streptococcus pneumoniae, random-effects meta-analysis
- MeSH terms
- Heptavalent Pneumococcal Conjugate Vaccine, Adolescent, Adult, Aged, Child, Preschool, Health Planning Guidelines, Humans, Meningitis, Pneumococcal, Pneumococcal Infections, Population Surveillance, Serotyping, Meta-Analysis as Topic, Databases as Topic, Pneumococcal Vaccines, Young Adult
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