Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan;33 Suppl 2(Suppl 2 Optimum Dosing of Pneumococcal Conjugate Vaccine For Infants 0 A Landscape Analysis of Evidence Supportin g Different Schedules):S140-51.
doi: 10.1097/INF.0000000000000082.

Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumonia

Jennifer D Loo  1 , Laura Conklin, Katherine E Fleming-Dutra, Maria Deloria Knoll, Daniel E Park, Jennifer Kirk, David Goldblatt, Katherine L O'Brien, Cynthia G Whitney
Affiliations
Free PMC article

Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumonia

Jennifer D Loo et al. Pediatr Infect Dis J. 2014 Jan.
Free PMC article

Abstract

Background: Pneumonia is the leading cause of morbidity and mortality among children <5 years of age globally. Pneumococcal conjugate vaccines (PCVs) are known to provide protection against vaccine serotype pneumococcal pneumonia; uncertainty exists regarding the optimum PCV dosing schedule.

Methods: We conducted a systematic review of studies published from 1994 to 2010 (supplemented post hoc with studies from 2011) documenting the effect of PCV dosing schedules on clinical and radiologically confirmed pneumonia, pneumococcal pneumonia and empyema among children of ages targeted to receive vaccine. Data on 2- and 3-dose schedules were included. Percent change of pneumonia incidence rates from baseline to most recent year post-PCV introduction was calculated.

Results: We identified 42 primary citations that evaluated PCV schedules and pneumonia. Thirty-seven (88%) were from North America, Europe or Australia; 37 (88%) evaluated PCV7 and 1 (2%) PCV10. Two studies (both observational) compared multiple schedules within the study. We found evidence of reduced clinical and radiologically confirmed pneumonia incidence for all schedules, including 2+1 (1 nonrandomized trial, 5 observational studies), 3+0 (5 randomized trials, 2 observational studies) and 3+1 (5 clinical trials, 24 observational studies) schedules. The magnitude of disease impact did not differ among schedules. Evidence for impact on pneumococcal pneumonia and empyema varied.

Conclusions: All schedules (2+1, 3+0 and 3+1) reduced clinical and radiologically confirmed pneumonia. Quantifying differences in pneumonia disease impact between schedules was difficult due to heterogeneity among studies in design, case definition and population. These findings support World Health Organization recommendations for 3-dose schedules administered as either 3+0 or 2+1 regimens. Pneumonia impact data are still needed on expanded serotype PCV products, developing country settings and the role for a booster dose.

PubMed Disclaimer

Conflict of interest statement

Support for this project was provided by Program for Appropriate Technology in Health (PATH) through funding from The GAVI Alliance. The views expressed by the authors do not necessarily reflect the views of CDC, GAVI, PATH or IVAC. M.D.K. has received support from Novartis for participation on a Data and Safety Monitoring Board, meeting travel reimbursement from Pfizer and grant support from Merck. D.G.’s laboratory performs contract and or collaborative research for/with Pfizer, GlaxoSmithKline, Merck, Novartis and Sanofi Pasteur. D.G. has received travel or honorarium support for participation in external expert committees for Merck, Sanofi Pasteur, Pfizer and GlaxoSmithKline. K.O.B. received grant support from Pfizer, GlaxoSmithKline and has received travel or honorarium support for participation in external expert committees for Merck, Aventis-pasteur and GlaxoSmithKline. The authors have no other funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Flowchart of included citations.
See this image and copyright information in PMC

References

    1. O’Brien KL, Wolfson LJ, Watt JP, et al. Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374:893–902. - PubMed
    1. World Health Organization. Estimated Hib and pneumococcal deaths for children under 5 years of age. 2008. Available at: http://www.who.int/immunization_monitoring/burden/Pneumo_hib_estimates/e.... Accessed March 18, 2013.
    1. Lucero MG, Dulalia VE, Parreno RN, et al. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and pneumonia with consolidation on x-ray in children under two years of age. Cochrane Database Syst Rev. 2004:CD004977. - PubMed
    1. World Health Organization. Pneumococcal conjugate vaccine for childhood immunization—WHO position paper. Wkly Epidemiol Rec. 2007;12:93–104. - PubMed
    1. World Health Organization and UNICEF. Global Action Plan for Prevention and Control of Pneumonia (GAPP). 2009 Available at: http://whqlibdoc.who.int/hq/2009/WHO_FCH_CAH_NCH_09.04_eng.pdf. Accessed March 18, 2013. - PMC - PubMed

Publication types

MeSH terms

Substances