Abstract
Implementation of pneumococcal conjugate vaccines in the Netherlands (PCV7 in 2006 and PCV10 in 2011) for infants caused a shift in serotypes in invasive pneumococcal disease (IPD). We explored sex differences in serotype-specific IPD incidence before and after vaccine introduction. Incidences in the pre-PCV7 (June 2004–May 2006), post-PCV7 (June 2008–May 2011) and post-PCV10 period (June 2013–May 2015), stratified by age, were compared. Incidence was higher in men for all age groups (overall in men: 16.7, 15.5 and 14.4/100,000 and women: 15.4, 13.6 and 13.9/100,000 pre-PCV7, post-PCV7 and post-PCV10, respectively), except for 20–39 year-olds after PCV7 and 40–64 year-olds after PCV10 introduction. After PCV7 and PCV10 introduction, the overall IPD incidence decreased in men aged 20–39 years (from 5.3 pre-PCV7 to 4.7 and 2.6/100,000 post-PCV7 and post-PCV10, respectively), whereas it showed a temporary increase in women (from 3.9/100,000 pre-PCV7 to 5.0/100,000 post-PCV7 and back to 4.0/100,000 post-PCV10) due to replacement disease. PCV10 herd effects were observed throughout, but in women older than 40 years, a significant increase in non-PCV10 serotype offset a decrease in overall IPD incidence. Ongoing surveillance of IPD incidence by sex is important to evaluate the long-term effects of PCV implementation.
Highlights
Sex differences play an important role in clinical disease susceptibility and outcome
The largest difference in invasive pneumococcal disease (IPD) incidence between men and women was observed in those at highest risk, i.e. children younger than 5 years and persons 65 years and older, but the F/M ratio was only significant for those 65 years and older (Figure 2, F/M incidence ratio)
Comparing post-PCV7 to pre-PCV7, there was a significant decrease in overall IPD incidence for children younger than 5 years and and people 65 years and older in both sexes
Summary
Sex differences play an important role in clinical disease susceptibility and outcome. With the exception of urinary tract infections, sex differences are often neglected in surveillance reports [4,5]. For Streptococcus pneumoniae, a frequent coloniser of the nasopharynx and cause of severe infections, the observed incidences of pneumococcal pneumonia and invasive pneumococcal disease (IPD) have been higher in men [6,7,8]. Young children have the highest pneumococcal carriage rates and are the key transmitters of S. pneumoniae in the population. No systematic age-specific differences in asymptomatic pneumococcal nasopharyngeal carriage rates have been observed between boys and girls [9,10,11]. Pneumococcal conjugate vaccination (PCV) has led to eradication of vaccine serotype carriage but immediate replacement by non-vaccine serotypes with a modest reduction in overall pneumococcal carriage in children [12,13]
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