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Title: Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites
Authors: Daniel R. Feikin
Eunice W. Kagucia
Jennifer D. Loo
Ruth Link-Gelles
Milo A. Puhan
Thomas Cherian
Orin S. Levine
Cynthia G. Whitney
Katherine L. O'Brien
Matthew R. Moore
Daniel R. Feikin
Ruth Link-Gelles
Thomas Cherian
Richard A. Adegbola
Mary Agocs
Krow Ampofo
Nick Andrews
Theresa Barton
Javier Benito
Claire V. Broome
Michael G. Bruce
Lisa R. Bulkow
Carrie L. Byington
Teresa Camou
Heather Cook
Suzanne Cotter
Ron Dagan
Philippe de Wals
Geneviève Deceuninck
Barbara Denham
Giles Edwards
Juhani Eskola
Margaret Fitzgerald
Emmanouil Galanakis
Gabriela Garcia-Gabarrot
Juan J. Garcia-Garcia
Amadeu Gene
Borja Gomez
Helen Heffernan
Thomas W. Hennessy
Sigrid Heuberger
Markus Hilty
Helene Ingels
Sanjay Jayasinghe
Eunice W. Kagucia
James D. Kellner
Nicola P. Klein
Andrea Kormann-Klement
Jana Kozakova
Vicki Krause
Paula Kriz
Lotte Lambertsen
Agnès Lepoutre
Orin S. Levine
Marc Lipsitch
Jennifer D. Loo
Mariana Lopez-Vega
Marguerite Lovgren
Sofia Maraki
Edward O. Mason
Peter B. McIntyre
Robert Menzies
Allison Messina
Elizabeth Miller
Santiago Mintegi
Matthew R. Moore
Jitka Motlova
Lawrence H. Moulton
Kathrin Mühlemann
Carmen Muñoz-Almagro
Katherine L. O'Brien
David R. Murdoch
Daniel E. Park
Milo A. Puhan
Arthur L. Reingold
Raquel Sa-Leao
Abanti Sanyal
Peter G. Smith
Lodewijk Spanjaard
Chonnamet Techasaensiri
Richard E. Thompson
Koh C. Thoon
Gregory J. Tyrrell
Palle Valentiner-Branth
Arie van der Ende
Otto G. Vanderkooi
Mark P.G. van der Linden
Emmanuelle Varon
Jan Verhaegen
Didrik F. Vestrheim
Imelda Vickers
Anne von Gottberg
Rüdiger von Kries
Pauline Waight
Robert Weatherholtz
Susanne Weiss
Cynthia G. Whitney
Arnold Yee
Anita K.M. Zaidi
Johns Hopkins Bloomberg School of Public Health
Centers for Disease Control and Prevention
Organisation Mondiale de la Sante
Glaxosmithkline Biologicals S.A.
University of Utah
Health Protection Agency
UT Southwestern Medical School
Cruces Universitary Hospital
Rollins School of Public Health
National Center for Infectious Diseases
Departamento de Laboratorios
Centre for Disease Control
Health Protection Surveillance Centre
Ben-Gurion University of the Negev
Institut National de Santé Publique
Quebec University Hospital Research Centre
Scottish Meningococcus and Pneumococcus Reference Laboratory
National Institute for Health and Welfare
Panepistimio Kritis
Hospital Sant Joan de Deu
ESR - Kenepuru Science Centre
Austrian Agency for Health and Food Safety
University of Bern
Statens Serum Institut
The University of Sydney
University of Calgary
Kaiser Permanente
National Institute of Public Health Prague
French Institute for Public Health Surveillance
Harvard School of Public Health
Provincial Laboratory for Public Health, Alberta
Heraklion University Hospital
Baylor College of Medicine
Children's Hospital At Westmead
All Children's Hospital St. Petersburg
University of Otago
University of California, Berkeley
Universidade Nova de Lisboa
London School of Hygiene & Tropical Medicine
Academic Medical Centre, University of Amsterdam
Mahidol University
National University of Singapore
Medizinische Fakultat und Universitats Klinikum Aachen
Hopital Europeen Georges-Pompidou
KU Leuven
Norwegian Institute of Public Health
Children's University Hospital, Dublin
National Institute for Communicable Diseases
Ludwig-Maximilians-Universitat Munchen
The Aga Khan University
Keywords: Medicine
Issue Date: 1-Sep-2013
Citation: PLoS Medicine. Vol.10, No.9 (2013)
Abstract: Background:Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction.Methods and Findings:Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data ≥2 years before and ≥1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children <5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0·55, 95% CI 0·46-0·65) and remained relatively stable through year 7 (RR 0·49, 95% CI 0·35-0·68). Point estimates for VT IPD decreased annually through year 7 (RR 0·03, 95% CI 0·01-0·10), while NVT IPD increased (year 7 RR 2·81, 95% CI 2·12-3·71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0·52, 95% CI 0·29-0·91], 50-64 year-olds [RR 0·84, 95% CI 0·77-0·93], and ≥65 year-olds [RR 0·74, 95% CI 0·58-0·95]).Conclusions:Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used.Please see later in the article for the Editors' Summary.
ISSN: 15491676
Appears in Collections:Scopus 2011-2015

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