Abstract
In the Community of Madrid, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent (PCV7) in the fully government-funded Regional Immunization Program (RIP) in May, 2010, but was later excluded in May, 2012, and included again in January, 2015. These unique changes allowed us to assess the impact of the different pneumococcal vaccination policies on PCV13 uptake in infants and on the incidence rate (IR) of invasive pneumococcal disease (IPD) in children <15 years old. In this prospective, active, surveillance study, we estimated PCV13 uptakes, IR and incidence rate ratios (IRR) for total IPD and for IPD caused by PCV13- and non-PCV13 serotypes in children <15 years, stratified by age, in four periods with different vaccination policies: fully government-funded PCV7 vaccination, fully government-funded PCV13, mixed public/private funding and only private funding. Vaccine uptakes reached 95% in periods with public-funded pneumococcal vaccination, but fell to 67% in the private funding period. Overall, IR of IPD decreased by 68% (p<0.001) in 2014–15, due to 93% reduction in the IR of PCV13-type IPD (p<0.001) without significant changes in non-PCV13-type IPD. A fully government-funded PCV13 vaccination program lead to high vaccine uptake and dramatic reductions in both overall and PCV13-type IPD IR. When this program was switched to private PCV13 vaccination, there was a fall in vaccine coverage and stagnation in the decline of PCV13-type IPD with data suggesting a weakening of herd immunity.
Highlights
The introduction of pneumococcal conjugate vaccines (PCVs) in childhood immunization programs has markedly decreased the incidence of invasive pneumococcal disease (IPD) [1,2,3,4]
Four periods were considered based on the different pneumococcal vaccination policies as follows: PCV7 period (1st, 2nd and 3rd periods, with free PCV7 vaccination in Regional Immunization Program (RIP)), PCV13 period (4th and 5th periods, with PCV13 included in the RIP), mixed public/private period (6th period in which free PCV13 vaccination was withdrawn from RIP for children born on or after the 1st of May of 2012, with free PCV13 universal vaccination for children born before this date to complete a 2+1 vaccination schedule), and private period (7th and 8th periods, with PCV13 vaccination paid for exclusively by children’s families)
In a total of 196 (22.8%) cases, S. pneumoniae was identified by polymerase chain reaction (PCR) (25 cases in the Private period); of them, 128 (65.3%) could be serotyped
Summary
The introduction of pneumococcal conjugate vaccines (PCVs) in childhood immunization programs has markedly decreased the incidence of invasive pneumococcal disease (IPD) [1,2,3,4]. Marked reductions have been reported in other countries as South Africa, where incidence of IPD after PCV introduction was 69% reduced, from 54.8 cases/100,000 inhabitants in the baseline period to 17.0 cases/100,000 inhabitants in 2012 [7]. Reductions in IPD were associated with profound changes in pneumococcal nasopharyngeal colonization in the post-vaccination era since vaccine serotypes have been greatly reduced or nearly eliminated [9,10,11]. High vaccination coverages could limit circulation within the community of pneumococcal serotypes with greater capacity to cause invasive disease (vaccine types) being replaced by serotypes with lower invasive capacity, as has been hypothesized in relation to otitis media [12]
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