Pneumococcal Conjugate Vaccine Breakthrough Infections: 2001–2016

Abstract

BACKGROUND: Most countries use 3-dose pneumococcal conjugate vaccine (PCV) schedules; a 4dose (3 primary and 1 booster) schedule is licensed for US infants. We evaluated the invasive pneumococcal disease (IPD) breakthrough infection incidence in children receiving 2 vs 3 primary PCV doses with and without booster doses (2 1 1 vs 3 1 1; 2 1 0 vs 3 1 0). METHODS:We used 2001-2016 Active Bacterial Core surveillance data to identify breakthrough infections (vaccine-type IPD in children receiving $1 7-valent pneumococcal conjugate vaccine [PCV7] or 13-valent pneumococcal conjugate vaccine [PCV13] dose) among children aged ,5 years. We estimated schedule-specific IPD incidence rates (IRs) per 100 000 personyears and compared incidence by schedule (2 1 1 vs 3 1 1; 2 1 0 vs 3 1 0) using rate differences (RDs) and incidence rate ratios. RESULTS:We identified 71 PCV7 and 49 PCV13 breakthrough infections among children receiving a schedule of interest. PCV13 breakthrough infection rates were higher in children aged ,1 year receiving the 2 1 0 (IR: 7.8) vs 3 1 0 (IR: 0.6) schedule (incidence rate ratio: 12.9; 95% confidence interval: 4.1-40.4); PCV7 results were similar. Differences in PCV13 breakthrough infection rates by schedule in children aged ,

Assessing reduced-dose pneumococcal vaccine schedules in South Africa

“…Second, the difference in carriage prevalence between dry and rainy seasons reported in previous studies 6 was not replicated in this study; whether this is a reflection of the difference in the epidemiology of carriage between groupable and non-groupable strains is not clear.…”

“…A US study in 2016 showed that the rate of breakthrough infection was higher for infants receiving two versus three primary doses. 6 The change in the UK schedule generated concern for infants. Time and robust surveillance will establish whether the 1 + 1 schedule maintains suppression of vaccine serotypes without increasing invasive pneumococcal disease during early infancy.…”

Post-vaccination outcomes in association with four COVID-19 vaccines in the Kingdom of Bahrain

“…Breakthrough infections after vaccination or natural infection have been reported for several viruses and bacteria 7 , 8 . With regards to COVID-19, several studies have described post vaccination infections, although symptoms and hospitalisations were less frequently reported among the vaccinated compared to the unvaccinated.…”

Continued Vaccine Breakthrough Cases of Serotype 3 Complicated Pneumonia in Vaccinated Children, Portugal (2016–2019)

“…The protection afforded by conjugate vaccines was never anticipated to be complete, and numerous studies have reported vaccine breakthroughs. In the US, most vaccine breakthrough cases in children <5 years old occurred during the first year of life and were due to serotypes 19F and 6B with PCV7 vaccination, and serotypes 19A and 3 with PCV13 vaccination ( 14 ). In Ireland, in patients ≤16 years old, most PCV13 vaccine breakthroughs occurred in cases of bacteremia without a focus by serotype 19A, although cases with serotypes 3, 6B, 7F, 14, and 19F were also found ( 15 ).…”

“…Since it is clear that serotype 3 PCPP would be severely underestimated under these conditions ( 1 , 4 , 6 , 9 , 12 ), this could potentially lead to overestimation of the VE against this serotype. Considering that vaccine breakthroughs occur with a 3 + 0 “unboosted,” but also with 2 + 1 and 3 + 1 boosted schedules, the PCV13 administration calendar seems to have only a minor influence on vaccine breakthroughs ( 1 , 4 , 14 – 16 ). Taken together, these data suggest that PCR-based methods should be more broadly used to identify the etiology of pediatric complicated pneumonia and of the serotypes which cause PCPP to better evaluate the impact of PCV13 on these important infections.…”