Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program

Moreira, Marta; Cintra, Otávio; Harriague, Julie; Hausdorff, William P.; Hoet, Bernard

doi:10.1016/j.vaccine.2016.04.006

Cited by 28 publications

(26 citation statements)

References 31 publications

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“…The ongoing tracking of asymptomatic carriers is a valuable tool to estimate and assess the impact of pneumococcal vaccine strategies, since pneumococcal colonisation is considered to reflect the circulating strains/serotypes responsible for diseases in the population and represents a precondition for their development. This is of paramount importance in Brazil since PCV10 was introduced for routine use in the area investigated a few months after the collection of the specimens analysed in this study and, currently, it is universally adopted (>90% coverage) [27]. Considering such purposes, our results corroborate earlier findings [5,22,24] indicating that the combination of culture-and molecular-based approaches can improve surveillance studies yielding more robust information.…”

Section: Resultssupporting

confidence: 86%

Pneumococcal nasopharyngeal carriage among children in Brazil prior to the introduction of the 10-valent conjugate vaccine: a culture- and PCR-based survey

et al. 2017

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We performed two different approaches (broth enrichment step prior to culture (BEC) and PCR (BEPCR)) for detecting Streptococcus pneumoniae from nasopharyngeal specimens collected from 242 children aged <6 years attending one hospital (n = 140) and one childcare centre (n = 102) in a major urban area in Brazil. These specimens were collected immediately before the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) and the 13-valent vaccine (PCV13) for routine use in Brazil. Results were compared with previous findings obtained with direct culture (DC) on a selective medium. Colonisation prevalence was 58·3% (n = 141), being higher among children attending the childcare centre (62·7% vs. 55%). The culture-based methods (DC and BEC) enabled the detection of S. pneumoniae in 119 (49·2%) and 115 (47·5%) children, respectively. The PCR-based method (BEPCR) was more sensitive and 137 (56·6%) carriers were identified. Twenty-six serogroups/serotypes were identified, predominantly 6B, 19F, 14, 6A, 15C and 23F. Multiple colonisation was observed in 13 (5·4%) children. The estimated serotypes coverage of available PCVs was 40·4% for the 10-valent (included in the Brazilian immunisation programme) and 55·8% for the 13-valent (only available in private clinics). The use of robust approaches to obtain a more realistic insight about the asymptomatic carrier status is of paramount importance to estimate and assess the impact of vaccine implementation. The combination between culture-based and molecular methods constitutes a suitable strategy.

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Section: Resultssupporting

confidence: 86%

Pneumococcal nasopharyngeal carriage among children in Brazil prior to the introduction of the 10-valent conjugate vaccine: a culture- and PCR-based survey

et al. 2017

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“…Studies in this review showed that PCV had both direct and indirect effects on the three clinical syndromes most relevant for hospitalization, in all different age-groups, schedules, countries, and study designs, except for very few instances in untargeted age groups [50]. A positive impact of PCV-10 was also shown in a review of studies conducted in Brazil on hospitalizations and deaths from pneumonia and IPD [51]. …”

Section: Discussionmentioning

confidence: 71%

Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

et al. 2016

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BackgroundSeveral Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs.ObjectivesWe aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region.MethodsWe conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies.ResultsWe identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design.ConclusionsAvailable evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.

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“…No decrease on IPD was observed in unvaccinated individuals from 2 to 17 years old, whereas an increase was observed in adults aged ≥ 18 years, in an interrupted time series analysis using data from the National Reference Laboratory (all IPD cases) and SINAN (only PM cases), adjusted for seasonality and temporal trends, in the pre- (2008)(2009) and post-vaccination (2011-2013) periods 19 . A review of the impact of PCV10 in Brazil found inconsistent data regarding herd protection 29 . * Except for p = 0, which is the probability of zero, the mean represents the relative risk.…”

Section: Discussionmentioning

confidence: 99%

Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era

et al. 2019

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OBJECTIVE: To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005–2009) and post-vaccination (2011–2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS: The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS: From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination – one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002–1.052). CONCLUSIONS: Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.

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Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program

Cited by 28 publications

References 31 publications

Pneumococcal nasopharyngeal carriage among children in Brazil prior to the introduction of the 10-valent conjugate vaccine: a culture- and PCR-based survey

Pneumococcal nasopharyngeal carriage among children in Brazil prior to the introduction of the 10-valent conjugate vaccine: a culture- and PCR-based survey

Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era

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