Articles
Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance

https://doi.org/10.1016/S1473-3099(14)71081-3Get rights and content

Summary

Background

In 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA.

Methods

We used laboratory-based and population-based data on incidence of IPD from the Active Bacterial Core surveillance (part of the Centers for Disease Control and Prevention's Emerging Infections Program) in a time-series model to compare rates of IPD before and after the introduction of PCV13. Cases of IPD between July 1, 2004, and June 30, 2013, were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13 minus PCV7). In a time-series model, we used an expected outcomes approach to compare the reported incidence of IPD to that which would have been expected if PCV13 had not replaced PCV7.

Findings

Compared with incidence expected among children younger than 5 years if PCV7 alone had been continued, incidence of IPD overall declined by 64% (95% interval estimate [95% IE] 59–68) and IPD caused by PCV13 minus PCV7 serotypes declined by 93% (91–94), by July, 2012, to June, 2013. Among adults, incidence of IPD overall also declined by 12–32% and IPD caused by PCV13 minus PCV7 type IPD declined by 58–72%, depending on age. We estimated that over 30 000 cases of IPD and 3000 deaths were averted in the first 3 years after the introduction of PCV13.

Interpretation

PCV13 reduced IPD across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations.

Funding

Centers for Disease Control and Prevention.

Introduction

Streptococcus pneumoniae, or pneumococcus, is a major cause of morbidity and mortality worldwide. In 2000, a seven-valent pneumococcal conjugate vaccine (PCV7, Prevnar, Wyeth [Collegeville, PA, USA]) was introduced into the routine infant immunisation programme in the USA, with a schedule of doses at 2, 4, 6, and 12–15 months of age.1 After the introduction of the vaccine, rates of invasive pneumococcal disease (IPD) caused by PCV7 serotypes declined substantially among children.2 Because PCV7 also prevented transmission of PCV7 serotypes, rates of IPD among unvaccinated groups also declined.2 PCV7 was also linked to reductions in otitis media outpatient visits3 and pneumonia hospital admissions.4 During subsequent years, serotype replacement resulted in increases in non-PCV7 type IPD that were moderate compared with the reductions in PCV7 type IPD.5 Despite these reductions, pneumococcus caused about 4 million episodes of disease in the USA in 2004, resulting in US$7·7 billion in direct and indirect costs.6

In 2010, a 13-valent conjugate vaccine (PCV13 (Prevnar-13, Pfizer, New York, NY, USA) replaced PCV7.7, 8 PCV13 included serotypes that caused replacement disease in the USA and was licensed without a randomised clinical trial. Therefore, after-licensure assessment was the first opportunity to measure the effects of PCV13 on prevention of IPD. In this study, we aimed to assess the population-level effect of PCV13 on incidence of IPD across all age groups and whether the introduction of PCV13 was associated with serotype replacement.

Section snippets

Study design

We used a long-standing surveillance system to compare rates of IPD before and after the introduction of PCV13. We identified IPD cases through Active Bacterial Core surveillance (ABCs), an active population-based and laboratory-based surveillance system that is part of the Centers for Disease Control and Prevention's (CDC's) Emerging Infections Program. ABCs methods are described in full elsewhere.9 We included cases identified from July 1, 2004, to June 30, 2013, in ten continuously

Results

Between July 1, 2004, and June 30, 2013, we identified 33 688 people with IPD, 30 014 (89%) of whom had serotyping results. The prevalence of at least one risk factor (apart from age) that is an indication for PCV13 or PPV237, 13 increased among children (p=0·009) and adults (p<0·0001) with IPD after the introduction of PCV13 (table 1). The proportions of cases resulting in hospital admission were also higher in the latter period in both groups (both p<0·0001), whereas case-fatality rates did

Discussion

Our analysis shows there were substantial and rapid reductions in IPD within 3 years of the introduction of PCV13 in the USA. The serotypes most affected were those most common before introduction of PCV13, particularly serotypes 19A and 7F. Also, the age groups that experienced the earliest reductions in PCV13 minus PCV7 type IPD were those targeted for vaccination: children younger than 5 years. These reductions became evident rapidly—within 6 months after introduction of PCV13—possibly

References (30)

  • MR Griffin et al.

    U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination

    N Engl J Med

    (2013)
  • DR Feikin et al.

    Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: a pooled analysis of multiple surveillance sites

    PLoS Med

    (2013)
  • 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)
  • 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)
  • Active Bacterial Core surveillance (ABCs)

  • Cited by (0)

    View full text