ArticlesEffect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance
Introduction
Streptococcus pneumoniae, or pneumococcus, is a major cause of morbidity and mortality worldwide. In 2000, a seven-valent pneumococcal conjugate vaccine (PCV7, Prevnar, Wyeth [Collegeville, PA, USA]) was introduced into the routine infant immunisation programme in the USA, with a schedule of doses at 2, 4, 6, and 12–15 months of age.1 After the introduction of the vaccine, rates of invasive pneumococcal disease (IPD) caused by PCV7 serotypes declined substantially among children.2 Because PCV7 also prevented transmission of PCV7 serotypes, rates of IPD among unvaccinated groups also declined.2 PCV7 was also linked to reductions in otitis media outpatient visits3 and pneumonia hospital admissions.4 During subsequent years, serotype replacement resulted in increases in non-PCV7 type IPD that were moderate compared with the reductions in PCV7 type IPD.5 Despite these reductions, pneumococcus caused about 4 million episodes of disease in the USA in 2004, resulting in US$7·7 billion in direct and indirect costs.6
In 2010, a 13-valent conjugate vaccine (PCV13 (Prevnar-13, Pfizer, New York, NY, USA) replaced PCV7.7, 8 PCV13 included serotypes that caused replacement disease in the USA and was licensed without a randomised clinical trial. Therefore, after-licensure assessment was the first opportunity to measure the effects of PCV13 on prevention of IPD. In this study, we aimed to assess the population-level effect of PCV13 on incidence of IPD across all age groups and whether the introduction of PCV13 was associated with serotype replacement.
Section snippets
Study design
We used a long-standing surveillance system to compare rates of IPD before and after the introduction of PCV13. We identified IPD cases through Active Bacterial Core surveillance (ABCs), an active population-based and laboratory-based surveillance system that is part of the Centers for Disease Control and Prevention's (CDC's) Emerging Infections Program. ABCs methods are described in full elsewhere.9 We included cases identified from July 1, 2004, to June 30, 2013, in ten continuously
Results
Between July 1, 2004, and June 30, 2013, we identified 33 688 people with IPD, 30 014 (89%) of whom had serotyping results. The prevalence of at least one risk factor (apart from age) that is an indication for PCV13 or PPV237, 13 increased among children (p=0·009) and adults (p<0·0001) with IPD after the introduction of PCV13 (table 1). The proportions of cases resulting in hospital admission were also higher in the latter period in both groups (both p<0·0001), whereas case-fatality rates did
Discussion
Our analysis shows there were substantial and rapid reductions in IPD within 3 years of the introduction of PCV13 in the USA. The serotypes most affected were those most common before introduction of PCV13, particularly serotypes 19A and 7F. Also, the age groups that experienced the earliest reductions in PCV13 minus PCV7 type IPD were those targeted for vaccination: children younger than 5 years. These reductions became evident rapidly—within 6 months after introduction of PCV13—possibly
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