24 Nov Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: The PSERENADE project
Y. Yang , M. D Knoll , C. Herbert , J C. Bennett , D. R Feikin , M. G Quesada , M K. Hetrich , S L. Zeger , E W. Kagucia , M. Xiao , A. L Cohen , M. van der Linden , Mignon du Plessis , I. Yildirim , B. A Winje , E. Varon , M. T Valenzuela , P. V Branth , A. Steens , J. A Scott , L. Savrasova , J. C Sanz , A. S Khan , K. Oishi , N.Nzoyikorera , J. P Nuorti , J.Mereckiene , K. McMahon , A.McGeer , G. A Mackenzie , L. MacDonald , S. N Ladhani , K.G Kristinsson , J. Kleynhans , J.D Kellner , S. Jayasinghe , Pak-Leung Ho , M. Hilty , L. L Hammitt , M. Guevara , C. Gilkison , R. Gierke , S. Desmet , P. De Wals , R. Dagan , E. Colzani , P. Ciruela , U. Chuluunbat , G. Chan , R. Camilli , M.G Bruce , Maria-Cristina C. Brandileone , K. Ampofo , K. L O’Brien , K. Hayford , The PSERENADE Team
Abstract
Background
Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally.
Methods
The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally. Site-specific meningitis incidence rate ratios (IRRs) comparing pre-PCV incidence to each year post-PCV10/13 were estimated by age (<5, 5–17 and ≥18 years) using Bayesian multi-level mixed effects Poisson regression, accounting for pre-PCV trends. All-site weighted average IRRs were estimated using linear mixed-effects regression stratified by age, product (PCV10 or PCV13) and prior PCV7 impact (none, moderate, or substantial). Changes in pneumococcal meningitis incidence were estimated overall and for product-specific vaccine-types and non-PCV13-types.
Results
Analyses included 10,168 cases <5 y from PCV13 sites and 2849 from PCV10 sites, 3711 and 1549 for 5–17 y and 29,187 and 5653 for ≥18 y from 42 surveillance sites (30 PCV13, 12 PCV10, 2 PCV10/13) in 30 countries, primarily high-income (84%). Six years after PCV10/PCV13 introduction, pneumococcal meningitis declined 48–74% across products and PCV7 impact strata for children <5 y, 35–62% for 5–17 y and 0–36% for ≥18 y. Impact against PCV10-types at PCV10 sites, and PCV13-types at PCV13 sites was high for all age groups (<5 y: 96–100%; 5–17 y: 77–85%; ≥18 y: 73–85%). After switching from PCV7 to PCV10/13, increases in non-PCV13-types were generally low to none for all age groups.
Conclusion
Pneumococcal meningitis declined in all age groups following PCV10/PCV13 introduction. Plateaus in non-PCV13-type meningitis suggest less replacement than for all IPD. Data from meningitis belt and high-burden settings were limited.
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