Sustained Reductions in Invasive Pneumococcal Disease in the Era of Conjugate Vaccine

Pilishvili, Tamara; Lexau, Catherine; Farley, Monica M.; Hadler, James L.; Harrison, Lee H.; Bennett, Nancy M.; Reingold, Arthur; Thomas, Ann; Schaffner, William; Craig, Allen S.; Smith, Philip J.; Beall, Bernard; Whitney, Cynthia G.; Moore, Matthew R.

doi:10.1086/648593

Cited by 1,161 publications

(952 citation statements)

References 40 publications

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“…The greatest reduction was in serotypes also contained in PCV7 (-88 %); while the six extra serotypes contained in PCV13 dropped by 30 %. It is not surprising that the six extra serotypes dropped less, because only the first 3 years after the switch to PCV13 in the infant vaccination programme were investigated, and it can take several years for herd protection effects to accumulate [77].…”

Section: Comparative Assessment Of Efficacy Data For Ppsv23 and Pcv13mentioning

confidence: 99%

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Falkenhorst

Remschmidt

Harder

et al. 2016

Bundesgesundheitsbl

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are members of the German Standing Committee on Vaccination (STIKO). Bundesgesundheitsblatt -Gesundheitsforschung -Gesundheitsschutz 12 · 2016 1624Tätigkeitsberichte Summary Background and objective The incidence of pneumococcal diseases among adults increases with age. Therefore, Germany's Standing Committee on Vaccination (Ständige Impfkommission, STIKO) has since 1998 recommended vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all people aged ≥60 years. PPSV23 has been the only pneumococcal vaccine licensed for adults until few years ago. Universal pneumococcal vaccination of infants, using a conjugate vaccine, has been recommended by STIKO since 2006. Since then, pneumococcal serotypes contained in conjugate vaccines have declined among cases of pneumococcal disease not only in children, but -through herd protection -also in older adults. The 13-valent pneumococcal conjugate vaccine (PCV13), currently used for most infants in Germany, has now been approved for use in adults as well. Data on the efficacy of PCV13 against clinical endpoints in older adults was published in 2015. For that reason, STIKO investigated whether one of the two vaccines (or the combination of both) should be preferred in order to reduce the burden of pneumococcal diseases in older adults, and at what age the vaccine should be given. Efficacy against invasive pneumococcal diseasesPooled data from 4 randomised controlled trials (RCTs) of PPSV23 in older adults show an efficacy of 73 % against invasive pneumococcal disease (IPD) caused by any serotype (95 % confidence interval [CI], 10-92 %). The IPD cases in these studies were mostly caused by one of the 23 serotypes contained in the vaccine. The efficacy of PCV13 in older adults was investigated in one RCT. Efficacy against IPD by any serotype was 49 % (95 % CI, 21-67 %, modified-intention-to-treat analysis). Efficacy against IPD by the 13 serotypes contained in the vaccine (VT-IPD) was 76 % (95 % CI, 47-90 %). Efficacy against pneumococcal pneumoniaAfter exclusion of 2 RCTs with a high risk of bias, pooled efficacy of PPSV23 against pneumococcal pneumonia (PP) caused by any serotype in the remaining 2 RCTs was 64 % (95 % CI, 35-80 %). In the included observational studies, pooled efficacy ranged from 37 % to 53 %, with broadly overlapping CIs, depending on study type. The efficacy of PCV13 against PP caused by any serotype was 22 % (95 % CI, 2-39 %), and against VT-PP it was 38 % (95 % CI, 14-55 %). Anticipated epidemiological and health economic effectsThe above-mentioned studies do not provide clear evidence of a difference between the two vaccines regarding efficacy against clinical endpoints (IPD, PP) caused by the serotypes contained in the respective vaccine. In the 2015-'16 season, 70 % of IPD cases in people aged ≥60 years were caused by PPSV23 serotypes, but only 30 % by PCV13 serotypes. Because PPSV23 contains all the serotypes in PCV13 (except for serotype 6A), vaccination with PPSV23 confers broader serotype coverage and can thereby prevent ...

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Section: Comparative Assessment Of Efficacy Data For Ppsv23 and Pcv13mentioning

confidence: 99%

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Falkenhorst

Remschmidt

Harder

et al. 2016

Bundesgesundheitsbl

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“…pneumococcal infections associated with certain chronic medical conditions have persisted. 20,21 Meanwhile some studies show that the indirect protection from conjugate generalized vaccination of children may benefit high-risk groups once herd immunity takes effect, 13 other studies show that despite widespread use of pneumococcal conjugate vaccines, rates of pneumonia and invasive pneumococcal disease remain disproportionately high in adults with at-risk conditions, including those with conditions not currently included in the Advisory Committee on Immunization Practices guidelines for prevention and those with multiple at-risk conditions. 14 Although the herd effects of the infant vaccination program using the 13 valent pneumococcal conjugate vaccine (PCV13) will in time indirectly protect people at high risk, suggesting then that PCV vaccination of high-risk groups may not provide substantial additional benefit, the burden of preventable pneumococcal disease will remain high during the first years after the introduction of the infant vaccination program.…”

Section: ããmentioning

confidence: 99%

Risk of hospitalization due to pneumococcal disease in adults in Spain. The CORIENNE study

Gil-Prieto

Pascual-García

Walter

et al. 2016

Human Vaccines & Immunotherapeutics

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“…Profound reductions in adult IPD from pediatric PCV7 and PCV13 National Immunization Programs (NIPs), through herd protection, have been regularly described. [6][7][8][9] For nonbacteremic pneumococcal CAP, however, the data do not permit similar conclusions. In fact, recent work from the United Kingdom, 10 United States, 11,12 and Spain, 13 as well as data from the CommunityAcquired Pneumonia immunization Trial in Adults document persistent circulation of PCV7 and PCV13 serotypes in patients with confirmed pneumococcal CAP several years after successful NIP implementation, suggesting that IPD cohorts are not accurate surrogates for CAP.…”

mentioning

confidence: 78%

Prevention of adult pneumococcal pneumonia with the 13-valent pneumococcal conjugate vaccine: CAPiTA, the community-acquired pneumonia immunization trial in adults

Istúriz

Webber

2015

Human Vaccines & Immunotherapeutics

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Sustained Reductions in Invasive Pneumococcal Disease in the Era of Conjugate Vaccine

Abstract: Dramatic reductions in IPD after PCV7 introduction in the United States remain evident 7 years later. IPD rates caused by serotype 19A and other non-PCV7 types have increased but remain low relative to decreases in PCV7-type IPD.

Cited by 1,161 publications

References 40 publications

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Risk of hospitalization due to pneumococcal disease in adults in Spain. The CORIENNE study

Prevention of adult pneumococcal pneumonia with the 13-valent pneumococcal conjugate vaccine: CAPiTA, the community-acquired pneumonia immunization trial in adults

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