A current and historical perspective on disparities in US childhood pneumococcal conjugate vaccine adherence and in rates of invasive pneumococcal disease: Considerations for the routinely-recommended, pediatric PCV dosing schedule in the United States

Abstract

Previous research has suggested that reducing the US 4-dose PCV13 schedule to a 3-dose schedule may provide cost savings, despite more childhood pneumococcal disease. The study also stressed that dose reduction should be coupled with improved PCV adherence, however, US PCV uptake has leveled-off since 2008. An estimated 24-36% of US children aged 5-19 months are already receiving a reduced PCV schedule (i.e., missing ≥1 dose). This raises a practical concern that, under a reduced, 3-dose schedule, a similar proportion of children may receive ≤2 doses. It is also unknown if a reduced, 3-dose PCV schedule in the United States will afford the same disease protection as 3-dose schedules used elsewhere, given lower US PCV adherence. Finally, more assurance is needed that, under a reduced schedule, racial, socioeconomic, and geographic disparities in PCV adherence will not correspond with disproportionately higher rates of pneumococcal disease among poor or minority children.

Keywords: pneumococcal conjugate vaccine (PCV), adherence, coverage, dosing schedule, disparities, race, minorities, socioeconomic status, pneumococcal disease, 2+1, 3+1.

Figure 1.

Invasive Pneumococcal Disease (IPD) Rates for Black and White US Persons (All Ages) Over Time, Active Bacterial Core Surveillance, 1997–2013.

Figure 2.

Percentage of US children who Received ≥4 Doses of PCV by Age 19–35 Months, National Immunization Survey, 2005–2013.CDC/NCHS and National Center for Immunization and Respiratory Diseases, National Immunization Survey. Available from: http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis and http://www.cdc.gov/nchs/nis.htm. See Appendix I, National Immunization Survey (NIS). Table 78.CDC. National, State, and Selected Local Area Vaccination Coverage among Children Aged 19–35 Months — United States, 2013. MMWR. Weekly / Vol. 63 / No. 34. August 29, 2014.

Figure 3.

Percentage of US Children who Received ≥1, ≥2, and ≥3 Doses of PCV by Age 3, 5, and 7 Months, respectively, National Immunization Survey, 2002–2013CDC/NCHS and National Center for Immunization and Respiratory Diseases, National Immunization Survey, Coverage Level by Milestones. Available from: http://www.cdc.gov/vaccines/imz-managers/coverage/nis/child/index.html.