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Incidence of invasive pneumococcal disease in Finland

Recent references on PCV10, PCV13, indirect protection and replacement

Following is a selection of some of the most relevat recent research articles on the effecs of pneumococcal conjugate vaccinations (PCV10 and PCV13) on IPD and carriage incidences and on indirect (herd) protection and serotype replacement. These results by and large support the underlying assumptions of the epidemiological model (Nurhonen and Auranen, 2014) and agree with predictions calculated using that model. Articles are linked to their Pub Med records and, in case of open access articles, also to the article itself.

PCV10 related studies

  • Palmu AA, Jokinen J, Borys D, et al. (2013)
    Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial. Lancet. Jan 19;381(9862):214-22

The researchers conducted a nationwide (Finland) cluster-randomised, double-blind trial, which showed high PCV10 effectiveness against invasive pneumococcal disease when given in different schedules.
Pub Med Record

  • De Wals P, Lefebvre B, Markowski F, et al. (2014)
    Impact of 2+1 pneumococcal conjugate vaccine program in the province of Quebec, Canada. Vaccine 32(13), 1501–1506

Based on laboratory surveillance data from 2000-2011, the researhers conclude that a PCV vaccination programme with high uptake is highly effective as IPD rates among the under 5 year olds decreased approximately 50% following PCV7 introduction in 2004 and somewhat further after PCV10 introduction in 2009. However, serotype replacement eroded benefits especially in adults.
Pub Med Record

  • Domingues CMAS, Verani JR, Montenegro Renoiner EI, et al (2014)
    Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study. Lancet Respir Med 2014; 2: 464–71.

Based on a a matched case-control study, the researchers found that in the routine immunisation programme in Brazil, PCV10 prevents invasive disease caused by vaccine serotypes and it might also provide cross-protection against some vaccine-related serotypes.
Pub Med Record

PCV13 related studies

  • Miller E, Andrews NJ, Waight PA, et al. (2011)
    Effectiveness of the new serotypes in the 13-valent pneumococcal conjugate vaccine. Vaccine. 2011 Nov 15;29(49):9127-31.

Using non-vaccine type IPD cases as controls, the researchers estimated vaccine effectiveness for the new PCV13 serotypes after PCV13 replaced PCV7 in 2010 in England and Wales. They found that IPD due to PCV13-only serotypes halved in children under 2 years in the one year long study period thus providing the first indication that the additional serotypes in PCV13 are efficacious.
Pub Med Record

  • van Hoek AJ, Sheppard CL, Andrews NJ, et al. (2014)
    Pneumococcal carriage in children and adults two years after introduction of the thirteen valent pneumococcal conjugate vaccine in England. Vaccine. 2014 Jul 23;32(34):4349-55.

The researchers conducted a pneumococcal carriage study and found that PCV13 serotype carriage has rapidly decreased post-PCV13 introduction in both vaccinated and unvaccinated individuals in all age goups. They found little change in the overall pneumococcal carriage rate in children across three studies conducted in 2001-2013. These results suggest both strong indirect (herd) protection and serotype replacement after vaccination.
Pub Med Record

  • Steens A1, Bergsaker MA, Aaberge IS, et al. (2013)
    Prompt effect of replacing the 7-valent pneumococcal conjugate vaccine with the 13-valent vaccine on the epidemiology of invasive pneumococcal disease in Norway. Vaccine. 2013 Dec 16;31(52):6232-8.

Using national registry data, the researchers found that vaccine-type IPD decreased both in the targeted (<5 years) and non-targeted (≥5) age groups since PCV7 introduction and further decreased after the replacement with PCV13. Only two cases of vaccine failure were identified. This indicates very high effectiveness of PCV7 or PCV13 and suggests that non-vaccinated individuals profit through indirect protection. Some non-vaccine type IPD incidences increased after PCV13 introduction suggesting serotype replacement.
Pub Med Record

Replacement study (pooled analysis)

  • Feikin DR, Kagucia EW, Loo JD, et al. (2013)
    Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: A pooled analysis of multiple surveillance sites. PLoS Medicine 10: e1001517

The researchers identified 21 databases worldwide that had pre and post vaccination IPD data and applied statistical meta-analysis to these data . Consistent and significant decreases in both overall and vaccine type IPD in children were found to occur quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Decreases in overall IPD among adults were smaller and occurred later than in children. (see note # below)

Pub Med Record
Open Access article

Herd immunity study (literature review)

  • Davis SM, Deloria-Knoll M, Kassa HT, O’Brien KL.(2013)
    Impact of pneumococcal conjugate vaccines on nasopharyngeal carriage and invasive disease among unvaccinated people: review of evidence on indirect effects.Vaccine 32(1):133–4510.

Based on randomized controlled trials, surveillance and other observational studies from 13 countries the researhers concluded that post-PCV7 introduction vaccine-type IPD and carriage consistently decreased among the non-targeted populations and that the indirect PCV impact on VT-IPD mediated by carriage has been significant. (see note # below)

Pub Med Record
Open Access article

(#) Note: The seven valent conjugate vaccine PCV7 is no longer made and extrapolation of the results in these articles to newer PCV10 and PCV13 formulations should be done cautiously. The results have relevance to PCV10 and PCV13 if these formulations affect nasopharyngeal colonization in a manner similar to that of PCV7. As of now, there is no evidence to suggest that this assumption does not hold.

Tendering process for pneumococcal conjugate vaccine
Parts of the assessment

Comparison criteria for vaccine   · Epidemiological modelling   · Economic evaluation

Background information

Sensitivity analysis · Replacement   · Pneumococcal vaccine products   · Finnish vaccination schedule   · Selected recent publications

Help for discussion and wiki editing

Pages in Finnish

Pneumokokkirokotteen hankinta  · Rokotteen vertailuperusteet · Epidemiologinen malli · Taloudellinen arviointi · Pneumokokkirokotteen turvallisuus

Work scheduling · Monitoring the effectiveness of the pneumococcal conjugate vaccine · Glossary of vaccine terminology