The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on serotype 19A invasive pneumococcal disease

Abstract

The circulation in the community of pneumococcal serotype 19A, a highly invasive and frequently extremely resistant pneumococcal strain, has increased the focus on methods to control its presence and effect. Two vaccines have been developed: the 10-valent pneumococcal conjugate vaccine (PCV10) and the 13-valent pneumococcal conjugate vaccine (PCV13). Available data indicate that PCV13 is highly effective in reducing the risk of serotype 19A invasive pneumococcal disease (IPD) in both vaccinated children and unvaccinated adults. Positive data have also been published for PCV10 that suggest that the conjugated serotype 19F included in the vaccine could evoke a cross-reactive antibody response with serotype 19A. However, a great number of invasive pneumococcal disease (IPD) cases are associated with serotypes not included in either of the vaccines, and preparation of a vaccine containing all the serotypes is unrealistic. Protein vaccines are the real future to definitively reduce the pneumococcal disease burden.

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

“…Moreover, as fluctuations in the frequency of the serotypes can occur without selective pressure of vaccines, and considering limitations in study design and small number of cases, it is not possible to attribute increases in non-vaccine serotypes to the reduction in vaccine-type circulation in a vaccinated population as pointed out by Hirose et al [19]. Reduction of carriage is fundamental to determine indirect and direct effects of pneumococcal vaccination with conjugate vaccines and it was highlighted in a systematic review where the reduction of risk on IPD due to 19A was discussed [61]. Additionally for robust conclusions it is important that countries implement surveillance, at least, to monitor the frequency of vaccine-type and non-vaccine type invasive pneumococcal disease in different age groups and for identification of factors influencing serotype distribution.…”

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

“…[73][74][75][76][77] PCV13 appeared efficient in preventing vaccine-type pneumococcal bacteraemia and non-bacteraemia CAP in the community-dwelling elderly population, as well as vaccine-type IPD, but not in preventing CAP from any cause. 26 PCV13 induced a higher immunological response (measured by OPA) than PPV23. 78 In addition, PPV23, followed 1 y later by PCV13 (PPSV23/PCV13), elicited significantly lower OPA titres than those produced after only an initial dose of PCV13 for all 13 serotypes.…”

“…[23][24][25] In recent years, the age indication for PCV13 was first extended from subjects aged 5 y to include those aged 50 y, and subsequently further extended to include all ages based on comparative immunogenicity data, including also the 18-64 y age group. 26 In the comparison of opsonophagocytic activity (OPA) titres between subjects 60-64 y of age, vaccinated either with PCV13 or PPV23, superiority was demonstrated for PCV13 with 9 of 12 common serotypes and noninferiority for the remaining 3, whereas the comparison between younger subjects only immunized with PCV13 and subjects in the 60-64 y age group vaccinated with PCV13 demonstrated consistently higher titres in younger vaccines. 26 The meta-analysis conducted in the Cochrane review found strong evidence of PPV23 efficacy against invasive pneumococcal disease (IPD).…”

“…26 In the comparison of opsonophagocytic activity (OPA) titres between subjects 60-64 y of age, vaccinated either with PCV13 or PPV23, superiority was demonstrated for PCV13 with 9 of 12 common serotypes and noninferiority for the remaining 3, whereas the comparison between younger subjects only immunized with PCV13 and subjects in the 60-64 y age group vaccinated with PCV13 demonstrated consistently higher titres in younger vaccines. 26 The meta-analysis conducted in the Cochrane review found strong evidence of PPV23 efficacy against invasive pneumococcal disease (IPD). 21 In particular, 11 studies involving 36,489 participants found a protective vaccine efficacy of 74% (95% CI 55% to 86%).…”

“…79 However, PCV13 protected the elderly adult population from 40 to 50% of the bacteraemic serotypes 80 and is well tolerated. 26,81 In summary, considering the pneumococcal vaccine status of different elderly populations, the interaction between PPV23 and PCV13 and the invasive serotypes throughout the European countries, a global strategy is needed to increase the efficacy of pneumococcal protection with both the available vaccines. However, it appears reasonable, as proposed by the new American Committee on Immunization Practice (ACIP) guidelines, to start by administering PCV13 and before giving PPV23 after 1 y.…”