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.
Auteur : Hanquet Germaine, Krizova Pavla, Valentiner-Branth Palle, Ladhani Shamez N, Nuorti J Pekka, Lepoutre Agnes, Mereckiene Jolita, Knol Mirjam, Winje Brita A, Ciruela Pilar, Ordobas Maria, Guevara Marcela, McDonald Eisin, Morfeldt Eva, Kozakova Jana, Slotved Hans-Christian, Fry Norman K, Rinta-Kokko Hanna, Varon Emmanuelle, Corcoran Mary, van der Ende Arie, Vestrheim Didrik F, Munoz-Almagro Carmen, Latasa Pello, Castilla Jesus, Smith Andrew, Henriques-Normark Birgitta, Whittaker Robert, Pastore Celentano Lucia, Savulescu Camelia
Thorax, 2018, p. 1-10