Successful Control of Streptococcus pneumoniae 19A Replacement With a Catch-up Primary Vaccination Program in Taiwan

Abstract

Background Streptococcus pneumoniae infections in Taiwan mostly occur in children aged 2–4 years. Because of a significant increase in the incidence of serotype 19A-related infections, the 13-valent pneumococcal conjugate vaccine (PCV13) was initially introduced in the national immunization program for children 2–5 years of age, prior to the national programs for infants. We have assessed the impact of such vaccination programs in reducing the incidence of invasive pneumococcal disease (IPD) in Taiwanese children. Methods We analyzed the national data on IPDs from the Taiwan Centers for Disease Control between 2008 and 2017. We calculated the incidence rates of IPD and incidence rate ratios (IRRs) between years for different serotypes to estimate the effectiveness of the vaccination programs. Results The national catch-up primary vaccination schedule successfully reduced the incidence rate of IPD from 17.8/100 000 in 2012 to 5.5/100 000 in 2017 among children aged 0–5 years. The IRR (2017 over 2012) was 0.31, corresponding to a 69% reduction. A modest herd effect was also observed, with a 37% reduction in the incidence of IPD in elderly people (≥70 years) from 2012 to 2017. The incidence of IPD caused by serotype 19A in children aged 0–5 years was reduced by 32.6–44.3% yearly from 2012 to 2017. In 2015, serogroup 15 outnumbered 19A, to become the leading serotypes in children 0–5 years old. Conclusions Special catch-up vaccination programs starting from children 2–5 years of age with PCV13 have been highly effective in reducing the incidence of IPD, especially as caused by serotype 19A, in Taiwanese children.

Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain23F-ST81, Taiwan

“…Although our study was performed at just 2 medical centers, the prevalent serotypes after implementation of PCV13 and the rates of β-lactam resistance we observed are consistent with national data for Taiwan (6). The PMEN1 lineage was not eliminated by PCV, and its spread is concerning.…”

“…In addition, Taiwan has an active surveillance system that made IPD a nationally notifiable disease in 2007. Therefore, doctors must report clinical information and submit pneumococcal isolates to the Taiwan CDC (6). This study was approved by the research ethics committee of CGMH, Taiwan (approval no.…”

Serotype Distribution and Antimicrobial Susceptibility of Streptococcus pneumoniae in Pre- and Post- PCV7/13 Eras, Taiwan, 2002–2018

“…To reduce the incidence of IPD in Taiwan, PCV7, PCV10, and PCV13 were introduced sequentially in late 2005, 2010, and 2011 for use in private sectors and have been freely provided by the government to children at high risks for IPD since 2009, 2010, and 2012, respectively (Lu et al, 2019). The reported uptake for at least 1 dose of PCVs in infants in Taiwan increased from 7.…”

“…children in 2014. Starting in 2015, PCV13 has been included in the routine immunization schedule for 2, 4, and 12 month-olds, and PCV13 uptake has been >80% after 2015 (Lu et al, 2019). PPV23 was provided free to ≥75 y.o.…”

“…are not currently available. National surveillance on IPD conducted in Taiwan during 2006-2017 observed a decreased incidence of IPD caused by PCV7 serotypes with a concurrent increased incidence of IPD caused by serotype 19A, which was subsequently controlled post-PCV13 (Lu et al, 2019). However, there have been limited reports on the trends of antimicrobial resistance in different pneumococcal serotypes post-PCV13.…”