TY - JOUR T1 - Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination JF - Thorax JO - Thorax SP - 473 LP - 482 DO - 10.1136/thoraxjnl-2018-211767 VL - 74 IS - 5 AU - Germaine Hanquet AU - Pavla Krizova AU - Palle Valentiner-Branth AU - Shamez N Ladhani AU - J Pekka Nuorti AU - Agnes Lepoutre AU - Jolita Mereckiene AU - Mirjam Knol AU - Brita A Winje AU - Pilar Ciruela AU - Maria Ordobas AU - Marcela Guevara AU - Eisin McDonald AU - Eva Morfeldt AU - Jana Kozakova AU - Hans-Christian Slotved AU - Norman K Fry AU - Hanna Rinta-Kokko AU - Emmanuelle Varon AU - Mary Corcoran AU - Arie van der Ende AU - Didrik F Vestrheim AU - Carmen Munoz-Almagro AU - Pello Latasa AU - Jesus Castilla AU - Andrew Smith AU - Birgitta Henriques-Normark AU - Robert Whittaker AU - Lucia Pastore Celentano AU - Camelia Savulescu A2 - , Y1 - 2019/05/01 UR - http://thorax.bmj.com/content/74/5/473.abstract N2 - 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. ER -