Switch in a childhood pneumococcal vaccination programme from PCV13 to PCV10: a defendable approach?

by Stefanie Desmet, Jan Verhaegen, Marc Van Ranst, Willy Peetermans, Katrien Lagrou

The Lancet Infectious Diseases, DOI: https://doi.org/10.1016/S1473-3099(18)30346-3

 

Pneumococcal vaccination is the cornerstone in the prevention of invasive pneumococcal disease. The use of the first pneumococcal conjugate vaccine in children, the 7-valent pneumococcal conjugate vaccine (PCV7), resulted in an important decline in vaccine serotype invasive pneumococcal disease. However, due to serotype replacement by serotypes not included in PCV7, the introduction of this vaccine was associated with a subsequent increase in non-vaccine serotypes. New conjugate vaccines were developed, including a 10-valent conjugate vaccine, PCV10 (including PCV7 serotypes plus ST1, ST5, ST7F), and a 13-valent vaccine, PCV13 (including PCV10 serotypes plus ST3, ST19A, ST6A). However, it is not clear which of these two vaccines should be used in childhood immunisation programmes because of uncertainties about serotype replacement, herd effects, and serotype-cross protection.

 

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The relative invasive disease potential of Streptococcus pneumoniae among children after PCV introduction: a systematic review and meta-analysis

by Balsells E, Dagan R, Yildirim I, Gounder PP, Steens A, Muñoz-Almagro C, Mameli C, Kandasamy R, Lavi NG, Daprai L, van der Ende A, Trzcinski K, Nzenze S, Meiring S, Foster D, Bulkow LR, Rudolph K, Valero-Rello A, Ducker S, Vestrheim DF, von Gottberg A, Pelton SI, Zuccotti G, Pollard AJ, Sanders EAM, Campbell H, Madhi SA, Nair H, Kyaw MH.

Published in J Infect. 2018 Jun 29. PMID: 29964140.

 

 

Researchers conducted a systematic review, supplemented by unpublished data, to identify data on the frequency of pneumococcal serotypes in carriage and invasive pneumococcal disease (IPD). The invasive disease potential of serotypes as the ratio of IPD in relation to carriage (odds ratio and 95%CI) was estimated and compared with 19A (reference serotype) by meta-analysis. Results based on a random effects model for children aged 0-23, 24-29, and 0-59 months and by invasive clinical syndromes are reported.

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Influence of Birth Cohort on Effectiveness of 2015–2016 Influenza Vaccine Against Medically Attended Illness Due to 2009 Pandemic Influenza A(H1N1) Virus in the United States

by Brendan Flannery, Catherine Smith, Rebecca J Garten, Min Z Levine, Jessie R Chung, Michael L Jackson, Lisa A Jackson, Arnold S Monto, Emily T Martin, Edward A Belongia Huong Q McLean, Manjusha Gaglani, Kempapura Murthy, Richard Zimmerman, Mary Patricia Nowalk, Marie R Griffin, H Keipp Talbot, John J Treanor, David E Wentworth, and Alicia M Fry

 

The effectiveness of influenza vaccine during 2015–2016 was reduced in some age groups as compared to that in previous 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09 virus)–predominant seasons. We hypothesized that the age at first exposure to specific influenza A(H1N1) viruses could influence vaccine effectiveness (VE).

 

We estimated the effectiveness of influenza vaccine against polymerase chain reaction–confirmed influenza A(H1N1)pdm09-associated medically attended illness from the 2010–2011 season through the 2015–2016 season, according to patient birth cohort using data from the Influenza Vaccine Effectiveness Network. Birth cohorts were defined a priori on the basis of likely immunologic priming with groups of influenza A(H1N1) viruses that circulated during 1918–2015. VE was calculated as 100 × [1 – adjusted odds ratio] from logistic regression models comparing the odds of vaccination among influenza virus–positive versus influenza test–negative patients.

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Epidemiological Data on the Effectiveness of Influenza Vaccine - Another Piece of the Puzzle

by Allen C Cheng and Kanta Subbarao

 

Vaccine effectiveness (VE) is defined as the reduction in risk of an outcome associated with vaccination. To keep up with ongoing antigenic drift in circulating influenza viruses resulting from immune pressure, the composition of influenza vaccine is reviewed each year and strains are changed as needed.

 

Since the emergence of 2009 pandemic influenza A(H1N1) viruses (A[H1N1]pdm09 viruses), they have gradually evolved into distinct genetic clades; the 6B clade was identified in 2013–2014, and the 6B1 clade was identified in 2015–2016. Short of conducting controlled clinical trials each year, we are left to rely on methods of monitoring vaccine effectiveness (VE) that are based on observational studies. Since the advent of highly specific influenza diagnostic tests based on nucleic acid detection, the test-negative study, a variant of a case-control study, has become widely used as a simple method to estimate VE.

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The Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Carriage in the Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA) Study

by Anna M M van Deursen, Marlies A van Houten, Chris Webber, Michael Patton, Daniel Scott, Scott Patterson, Qin Jiang, William C Gruber, Beate Schmoele-Thoma, Diederick E Grobbee, Marc J M Bonten, Elisabeth A M Sanders

 

The impact of pneumococcal conjugate vaccination on the prevalence of nasopharyngeal carriage with pneumococci and other bacteria in adults is unknown. The direct effects of the 13-valent pneumococcal conjugate vaccine (PCV13) in community dwelling older adults was investigated as part of the randomized controlled Community Acquired Pneumonia immunization Trial in Adults (CAPiTA).

 

Researchers determined the carriage of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis before and 6, 12, and 24 months after vaccination using polymerase chain reaction (PCR)–based methods and conventional cultures of nasopharyngeal and oropharyngeal swab samples in 1006 PCV13 recipients and 1005 controls. Serotyping of the 13 vaccine-type (VT) pneumococci was performed by PCR targeting capsular synthesis genes and Quellung reaction of isolates.

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