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. 2015 Jul 1;10(7):e0131494.
doi: 10.1371/journal.pone.0131494. eCollection 2015.

Effects of Infant Pneumococcal Conjugate Vaccination on Serotype Distribution in Invasive Pneumococcal Disease among Children and Adults in Germany

Affiliations

Effects of Infant Pneumococcal Conjugate Vaccination on Serotype Distribution in Invasive Pneumococcal Disease among Children and Adults in Germany

Mark van der Linden et al. PLoS One. .

Abstract

This study describes the effects of the introduction of universal infant pneumococcal conjugate vaccination in 2006 on invasive pneumococcal disease (IPD) among children and adults in Germany with a focus on the dynamics of serotype distribution in vaccinated and non-vaccinated age groups. Over a period of 22 years (1992-2014), microbiological diagnostic laboratories from all over Germany have been sending isolates of IPD cases to the German National Reference Center for Streptococci on a voluntary basis. Streptococcus pneumoniae isolates were serotyped using Neufeld's Quellung method. Among children <16 years, the proportion of PCV7 serotypes among isolates from IPD cases decreased from 61.8% before vaccination (1997-2006) to 23.5% in the early vaccination period (2007-2010; p = 1.30E-72) and sank further to 5.2% in the late vaccination period (2010-2014; p = 4.59E-25). Similar reductions were seen for the separate age groups <2 years, 2-4 years and 5-15 years. Among adults, the proportion of PCV7 serotypes decreased from 43.4% in the pre-vaccination period (1992-2006) to 24.7% (p = 3.78E-88) in the early vaccination period and 8.2% (p = 5.97E-161) in the late vaccination period. Both among children and among adults, the non-PCV7 serotypes 1, 3, 7F and 19A significantly increased in the early vaccination period. After the switch from PCV7 to PVC10/PCV13 for infant vaccination in 2010, serotypes 1, 6A and 7F significantly decreased. A decrease in serotype 19A was only observed in 2013-2014, as compared to 2010-2011 (children p = 4.16E-04, adults p = 6.98E-06). Among adults, serotype 3, which strongly increased in the early vaccination period (p = 4.44E-15), remained at a constant proportion in the late vaccination period. The proportion of non-PCV13 vaccine serotypes increased over the whole vaccination period, with serotypes 10A, 12F, 23B, 24F and 38 most significantly increasing among children and serotypes 6C, 12F, 15A, 22F and 23B increasing among adults. Eight years of childhood pneumococcal conjugate vaccination have had a strong effect on the pneumococcal population in Germany, both among the target group for vaccination as well as among older children and adults.

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Conflict of interest statement

Competing Interests: MvdL has is member of advisory boards for, and has received speaker horaria from Pfizer, Merck and SanofiPasteurMSD. This study was in part funded by Pfizer Pharma GmbH and Sanofi Pasteur MSD Germany. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Age distribution of reported IPD isolates (1992–2014) in Germany (n = 24,235).
Left y-axis: number of reported cases, right y-axis cumulative percentage of all cases. Data represent the age distribution of isolates sent to the GNRCS on a voluntary basis. Since the surveillance system was improved several times (see materials and methods section), the graph does not necessarily represent the actual prevalence of IPD in the different age groups in Germany.
Fig 2
Fig 2. Numbers of reported IPD isolates among children (n = 3,853, all serotyped) and adults (n = 20,382, serotyped: n = 20,104) in Germany.
Fig 3
Fig 3. Isolates from IPD cases in Germany from 1997/1998 to 2013/2014 according to age groups and PCV7 vaccine-type (red), PCV13-non-PCV7 vaccine-type (blue) or non-PCV13 vaccine-type (green).
The total number of IPD cases is shown in black.
Fig 4
Fig 4. Serotype distribution of IPD cases among children (1997–2014, A) and adults (2007–2014, B) in Germany.
Blue: PCV7 serotypes, Green: PCV10-PCV7 serotypes, Orange: PCV13-PCV10 serotypes, Black/Gray: major non-PCV13 serotypes, Purple: other non-PCV13 serotypes.

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