Abstract
We assessed the impact of 10-valent and 13-valent pneumococcal vaccines (PCV10 and PCV13), which were introduced in Germany in 2009, on the incidence of meningitis and non-meningitis invasive pneumococcal disease (IPD) in children aged under 16 years in a population previously vaccinated with a seven-valent vaccine (PCV7). Surveillance of IPD (isolation of Streptococcus pneumonia from a normally sterile body site) is based on data from two independent reporting sources: hospitals and laboratories. IPD incidence was estimated by capture-recapture analysis. Incidence rate ratios (IRRs) were calculated for 2009 and 2012, thus comparing pre- and post-PCV10 and PCV13 data. IPD incidence caused by serotypes included in PCV13 decreased in all age and diagnosis groups. A rise in non-vaccine serotype incidence was seen only in children aged under two years. The overall impact varied by age group and infection site: for meningitis IPD in children aged under 2, 2-4 and 5-15 years, incidence changed by 3% (95% CI: -31 to 52), -60% (95% CI: -81 to -17) and -9% (95% CI: -46 to 53), respectively. A more pronounced incidence reduction was observed for non-meningitis IPD: -30% (95% CI: -46 to -7), -39% (95% CI: -54 to -20) and -83% (95% CI: -89 to -73) in children aged under 2, 2-4 and 5-15 years, respectively. A higher tropism of the additional serotypes for non-meningitis IPD may be a potential explanation. The heterogeneous findings emphasise the need for rigorous surveillance
Highlights
The German Standing Committee on Vaccination (STIKO) included seven-valent pneumococcal conjugate vaccine (PCV7) in the infant vaccination calendar for all infants as of July 2006, with a 3 + 1 schedule given at 2, 3, 4 and 11–14 months of age [1]
Rising non-PCV7 serotype incidences were observed in other countries: the most recent and comprehensive meta-analysis of the impact of PCV7 in different populations showed a reduction of about 50% for the incidence of all invasive pneumococcal disease (IPD) and about 60% for meningitis IPD [3]
From 2009 to 2012, there was a decrease in the incidence of IPD caused by serotypes included in PCV13 in all age groups for non-meningitis IPD, whereas a decrease for meningitis IPD could be observed in one age group (2–4 years) only
Summary
The German Standing Committee on Vaccination (STIKO) included seven-valent pneumococcal conjugate vaccine (PCV7) in the infant vaccination calendar for all infants as of July 2006, with a 3 + 1 schedule given at 2, 3, 4 and 11–14 months of age [1]. In Germany, the switch to higher-valent vaccines took place in April 2009 with the introduction of a 10-valent vaccine (PCV10) (market share in 2010–12: 9%) and in December 2009, when the 13-valent vaccine (PCV13) was introduced (market share in 2010–2012: 91%, internal sales figures provided by Pfizer Pharma GmbH). These higher-valent vaccines include all the serotypes in PCV7 and the most frequent non-PCV7 serotypes (PCV10: 1, 5, 7F; PCV13: 1, 3, 5, 6A, 7F and 19A). As 73.6% of all IPD cases in children aged under 16 years in Germany from 2007 to 2009 were caused by PCV13 serotypes [2] and given that the effectiveness of the six additional serotypes in PCV13 has been established using the Broome method [4], a considerable benefit from the switch to higher-valent pneumococcal vaccines was expected
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