Abstract
OverviewThe protective effect of infant pneumococcal conjugate vaccine (PCV) recommendation can be seen in Germany as a whole and in smaller regional groups. Comparisons between population-normalized geographic regions of Germany show different serotype distributions after program implementation, particularly in non-vaccine serotypes. The prior distinct differences in serotype distribution in children between the former East and former West German federal states have vanished. Children under six remain a vulnerable group, but the occurrence of vaccine-type (VT) invasive pneumococcal disease (IPD) in children correctly vaccinated (using a three-dose primary series plus one booster dose) with PCV13 was low (9 out of 374 cases, 2.4%). However, only 18.4% of children in Germany with IPD were correctly vaccinated with PCV13 according to the recommended schedule. Continued surveillance and better schedule adherence are essential to definitively establish the most effective PCV administration schedule.Vaccination effectsFor all PCV products used in Germany (PCV7, PCV10, and PCV13), vaccination status was the most common statistically significant predictor of infection with a particular serotype: Unvaccinated children old enough to have received at least one dose of vaccine in the PCV7 group had significantly higher odds (OR: 6.84, 95%CI: 2.66–22.06, adjusted for per capita income and residence in the northeastern federal states) of contracting VT IPD. In the PCV10 group, VT IPD had an OR of 4.52 (95% CI: 1.60–15.62, adjusted for year of infection, median household size, and residence in the southern federal states) in unvaccinated children, and in the PCV13 group, unvaccinated children continued to have higher odds (OR: 6.21, 95%CI: 3.45–11.36, adjusted for year of infection, age of child, per capita income, residence in the southern federal states, and percentage of children using public daycare) of getting vaccine-type IPD. Being unvaccinated was the most frequent significant indicator for infection with vaccine-type serotypes for each analysis group, while geographic groupings showed more limited potential to predict serotype of infection in early childhood IPD in Germany.
Highlights
Invasive pneumococcal disease (IPD) is responsible for nearly half a million deaths per year in children under five, and represents 5% of all-cause child mortality [1]
Disease surveillance on pediatric IPD is ongoing throughout the world, with a notable uptick following the development of pneumococcal conjugate vaccines (PCVs), which are a common component of childhood immunization programs [2]
The sample collection of the German National Reference Center for Streptococci (GNRCS) is generated by voluntarily-participating hospital and commercial microbiological laboratories throughout Germany
Summary
Invasive pneumococcal disease (IPD) is responsible for nearly half a million deaths per year in children under five, and represents 5% of all-cause child mortality [1]. Disease surveillance on pediatric IPD is ongoing throughout the world, with a notable uptick following the development of pneumococcal conjugate vaccines (PCVs), which are a common component of childhood immunization programs [2]. PCV13 currently has the vast market share of infant pneumococcal vaccination in Germany [3]. The Standing Committee on Vaccinations of the Robert Koch Institute (STIKO) issued a recommendation for all infants to receive the pneumococcal conjugate vaccine in 2006 (a recommendation for premature, chronically ill, or immunodeficient children was made in 2001 [4]), using a 3+1 (third, and fourth, and fifth month of life, with a booster at 11–14 months) schedule [5], and in August 2015, announced a change to a 2+1 dosing schedule (third and fifth months of life, with a booster at 11–14 months) [6]. We describe the impact of vaccination status, as well as geographic and demographic factors, on IPD cases for each of the three PCVs over three age cohorts, and examine the changes in serotype distribution in four population-normalized geographic analysis groups
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