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Original article
Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination
  1. Germaine Hanquet1,2,
  2. Pavla Krizova3,
  3. Palle Valentiner-Branth4,
  4. Shamez N Ladhani5,
  5. J Pekka Nuorti6,7,
  6. Agnes Lepoutre8,
  7. Jolita Mereckiene9,
  8. Mirjam Knol10,
  9. Brita A Winje11,
  10. Pilar Ciruela12,13,
  11. Maria Ordobas14,
  12. Marcela Guevara13,15,
  13. Eisin McDonald16,
  14. Eva Morfeldt17,
  15. Jana Kozakova3,
  16. Hans-Christian Slotved4,
  17. Norman K Fry5,
  18. Hanna Rinta-Kokko6,
  19. Emmanuelle Varon18,
  20. Mary Corcoran19,
  21. Arie van der Ende20,
  22. Didrik F Vestrheim11,
  23. Carmen Munoz-Almagro13,21,
  24. Pello Latasa14,
  25. Jesus Castilla13,15,
  26. Andrew Smith22,
  27. Birgitta Henriques-Normark17,23,24,
  28. Robert Whittaker25,
  29. Lucia Pastore Celentano25,
  30. Camelia Savulescu1
  31. on behalf of The SpIDnet/I-MOVE+ Pneumo Group
    1. 1 EpiConcept, Paris, France
    2. 2 Antwerp University, Antwerp, Belgium
    3. 3 National Institute of Public Health, Prague, Czech Republic
    4. 4 Statens Serum Institut, Copenhagen, Denmark
    5. 5 Public Health England, London, UK
    6. 6 National Institute for Health and Welfare, Helsinki, Finland
    7. 7 University of Tampere, Tampere, Finland
    8. 8 Santé publique France, Saint-Maurice, France
    9. 9 Health Protection Surveillance Centre, Dublin, Ireland
    10. 10 National Institute for Public Health and the Environment, Bilthoven, The Netherlands
    11. 11 Norwegian Institute of Public Health, Oslo, Norway
    12. 12 Public Health Agency of Catalunya, Barcelona, Spain
    13. 13 CIBER Epidemiología y Salud Pública, Madrid, Spain
    14. 14 General Directorate of Public Health, Madrid, Spain
    15. 15 Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain
    16. 16 Health Protection Scotland, National Services Scotland, Glasgow, UK
    17. 17 Public Health Agency of Sweden, Solna, Sweden
    18. 18 National Centre for Pneumococci, European Hospital George Pompidou, Paris, France
    19. 19 Irish Pneumococcal Reference Laboratory, Temple Street Children’s University Hospital, Dublin, Ireland
    20. 20 Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, Amsterdam, The Netherlands
    21. 21 Instituto de Recerca Pediátrica, Hospital Sant Joan de Deu, Universitat Internacional de Catalunya, Barcelona, Spain
    22. 22 Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK
    23. 23 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
    24. 24 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
    25. 25 European Centre for Disease Prevention and Control, Stockholm, Sweden
    1. Correspondence to Dr Germaine Hanquet, Epidemiology Department, EpiConcept, Paris 75012, France; ghanquet{at}


    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.

    • bacterial infection
    • clinical epidemiology

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    • Contributors GMH performed the statistical analyses of the pooled data and wrote the manuscript. CS was responsible for study coordination, collected data from the SpIDnet sites, contributed to the statistical analyses and writing of the manuscript. SNL and RW contributed to the writing of the manuscript. LPC provided technical support for the study design. PK, PV-B, SNL, NKF, JPN, HR-K, AL, EV, JM, MC, MK, H-CS, AvdE, BAW, DFV, EMD, JK, AS, PC, CM-A, MO, PL, MG, JC, EM and BH-N coordinated the collection, validation and preparation of data at site level. All authors read, commented on and approved all versions of the manuscript. Authors are included in alphabetical order of the country of the participating sites, except for first and last authors.

    • Funding This study was co-funded by participating countries, the ECDC (SpIDnet project) and the European Commission (Horizon 2020, I-MOVE+).

    • 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).

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Czech Republic: Helena Sebestova, Marek Maly. Denmark: Kurt Fuursted, Tine Dalby, Victoria F de Casadevante, Zitta Harboe, Charlotte Sværke Jørgensen. England and Wales: Sarah Collins, Nick Andrews, Abdelmajid Djennad, Richard Pebody. Finland: Jukka Jokinen. France: Emmanuel Belchior, Daniel Levy-Bruhl, Scarlett Georges, Marie-Cécile Ploy, Jacques Gaillat. Ireland: Robert Cunney, Hilary Humphreys, Suzanne Cotter. The Netherlands: Elisabeth Sanders, Wim van der Hoek, Guy Berbers, Hester de Melker. Norway: Marianne Bergsaker. Scotland: Claire Cameron, Barbara Denham. Catalonia, Spain: Conchita Izquierdo, Sonia Broner, Roman Pallarés. Madrid, Spain: Luis Garcia, Juan Carlos Sanz. Navarra, Spain: Carmen Ezpeleta, Alberto Gil-Setas. Sweden: Tiia Lepp, Ann Lindstrand, Jessica Darenberg. ECDC: Edoardo Colzani SpIDnet /I-MOVE+ coordination team: Marta Valenciano, Alain Moren.

    • Correction notice This article has been corrected since it was published Online First. Some of the information from Figures 4A, 4B and 4C for countries under a universal PCV10 program was missing from the image.

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