Abstract
BackgroundLimited data are available on the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) in resource-poor settings and PCV naïve populations. The Dominican Republic introduced PCV13 in September 2013 using a 2 + 1 schedule (2, 4, and 12 months) without a catch-up campaign. We evaluated PCV13 effectiveness against vaccine-type (VT) invasive pneumococcal disease (IPD) among children in the Dominican Republic.MethodsWe conducted a matched case-control study. A case-patient was defined as VT-IPD identified by culture or polymerase chain reaction (PCR) from a normally sterile-site in a hospitalized child who was age-eligible to have received ≥1 PCV13 dose. Four age- and neighborhood-matched controls were enrolled for each case-patient. We collected demographic, vaccination history, and risk factor data. Conditional logistic regression was performed. Vaccine effectiveness was calculated as (1- adjusted matched odds ratio for vaccination) X 100%.ResultsWe enrolled 39 case-patients and 149 matched-controls. Most case-patients had pneumonia with pleural effusion (64%), followed by meningitis (28%) and septicemia (13%). The most common pneumococcal serotypes identified included 14 (18%), 3 (13%), 19A (10%), and 1 (8%). Fewer case-patients had ≥1 PCV13 dose as compared to controls (61.5% vs. 80.0%; p = 0.006). Adjusting for malnutrition and socioeconomic status, VE of ≥1 PCV13 dose compared to no doses was 67.2% (95% CI: 2.3% to 90.0%). Only 44% of controls were up-to-date for PCV13, suggesting low vaccine coverage in the population.ConclusionsWe found that PCV13 provided individual protection against VT-IPD in this resource-poor setting with a PCV-naïve population, despite low PCV13 coverage. Expanding vaccination coverage might increase PCV13 impact.
Highlights
Limited data are available on the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) in resource-poor settings and PCV naïve populations
The first generation PCVs (PCV7 and Nine-valent pneumococcal conjugate vaccine (PCV9)) were shown to be effective in clinical trials and in practice [4,5,6,7,8], but limited data are available on the second generation PCVs (PCV10 and Thirteen-valent pneumococcal conjugate vaccine (PCV13)), in particular from low- and middle-income countries where three-dose schedules for PCVs have been implemented
A casepatient was defined as a vaccine type (VT)-S. pneumoniae identified from a normally sterile-site specimen in a hospitalized child who was age-eligible to have received at least one dose of PCV13, and not previously enrolled in the study
Summary
Limited data are available on the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) in resource-poor settings and PCV naïve populations. We evaluated PCV13 effectiveness against vaccine-type (VT) invasive pneumococcal disease (IPD) among children in the Dominican Republic. 70 to 80% of IPD cases among children less than five years old in Latin America are caused by pneumococcal serotypes included in the ten-valent (PCV10) or thirteen-valent (PCV13) vaccines [3]. In South Africa the population was not PCV naïve because PCV13 replaced PCV7 in 2011 and the country was the site of a PCV clinical trial, while in Brazil, a catch-up campaign and four doses of PCV were used, rather than the more-commonly used 3-dose schedule [9,10,11]. Questions still remain about the performance of PCV in a “typical” resource-poor setting, including the effectiveness of PCV13 in a population with no prior PCV use (i.e. PCV naïve populations) using a three dose (i.e., 2 + 1) schedule
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
