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. 2014 Jun 3;9(6):e98128.
doi: 10.1371/journal.pone.0098128. eCollection 2014.

Direct effect of 10-valent conjugate pneumococcal vaccination on pneumococcal carriage in children Brazil

Ana Lucia Andrade  1 , Yves Mauro Ternes  2 , Maria Aparecida Vieira  3 , Weslley Garcia Moreira  4 , Juliana Lamaro-Cardoso  5 , André Kipnis  5 , Maria Regina Cardoso  6 , Maria Cristina Brandileone  7 , Iaci Moura  8 , Fabiana C Pimenta  8 , Maria da Gloria Carvalho  8 , Fabricia Oliveira Saraiva  1 , Cristiana Maria Toscano  1 , Ruth Minamisava  9
Affiliations

Direct effect of 10-valent conjugate pneumococcal vaccination on pneumococcal carriage in children Brazil

Ana Lucia Andrade et al. PLoS One. .

Abstract

Background: 10-valent conjugate pneumococcal vaccine/PCV10 was introduced in the Brazilian National Immunization Program along the year of 2010. We assessed the direct effectiveness of PCV10 vaccination in preventing nasopharyngeal/NP pneumococcal carriage in infants.

Methods: A cross-sectional population-based household survey was conducted in Goiania Brazil, from December/2010-February/2011 targeting children aged 7-11 m and 15-18 m. Participants were selected using a systematic sampling. NP swabs, demographic data, and vaccination status were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by a positive culture and serotyping was performed by Quellung reaction. Rate ratio/RR was calculated as the ratio between the prevalence of vaccine-types carriage in children exposed to different schedules and unvaccinated for PCV10. Adjusted RR was estimated using Poisson regression. PCV10 effectiveness/VE on vaccine-type carriage was calculated as 1-RR*100.

Results: The prevalence of pneumococcal carriage was 41.0% (95%CI: 38.4-43.7). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Vaccine serotypes 6B (11.6%), 23F (7.8%), 14 (6.8%), and 19F (6.6%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction in pneumococcal vaccine-type carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2-57.1; p = 0.030) and 44.0% (95%CI: 14.-63.5; p = 0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p = 0.905).

Conclusion: PCV10 was associated with high protection against vaccine-type carriage with 2p+0 and 3p+0 doses for children vaccinated before the second semester of life. The continuous evaluation of carriage serotypes distribution is likely to be useful for evaluating the long-term effectiveness and impact of pneumococcal vaccination on serotypes reduction.

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Conflict of interest statement

Competing Interests: The authors state that ALA and MCCB have received travel grants from Pfizer and GSK for participation at meetings, and that this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Distribution of pneumococcal serotypes carriage in children 7–18 months of age. Goiania, December/2010-February/2011.
Other serotypes: 9A, 9N, 10A, 15A, 17F, 18A, 20, 21, 22F, 23A, 23B, 24F, 25A, 28A, 29, 31, 33F, 34, 35F.
See this image and copyright information in PMC

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