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. 2016;12(2):285-92.
doi: 10.1080/21645515.2015.1117713.

Evaluating the impact of PCV-10 on invasive pneumococcal disease in Brazil: A time-series analysis

Ana Lucia Andrade  1 , Ruth Minamisava  2 , Gabriela Policena  1 , Elier B Cristo  3 , Carla Magda S Domingues  4 , Maria Cristina de Cunto Brandileone  5 , Samanta Cristine Grassi Almeida  5 , Cristiana Maria Toscano  1 , Ana Luiza Bierrenbach  1
Affiliations

Evaluating the impact of PCV-10 on invasive pneumococcal disease in Brazil: A time-series analysis

Ana Lucia Andrade et al. Hum Vaccin Immunother. 2016.

Abstract

Routine infant immunization with 10-valent pneumococcal conjugate vaccine (PCV-10) began in Brazil in 2010. The impact of the PCV-10 on rates of invasive pneumococcal disease (IPD) at the population level was not yet evaluated. Serotype-specific IPD changes after PCV-10 introduction is still to be determined. Data from national surveillance system for notifiable diseases (SINAN) and national reference laboratory for S. pneumoniae in Brazil (IAL) were linked to enhance case ascertainment of IPD. An interrupted time-series analysis was conducted to predict trends in the postvaccination IPD rates in the absence of PCV-10 vaccination, taking into consideration seasonality and secular trends. PCVs serotype-specific distribution were assessed before (2008-2009) and after (2011-2013) the introduction of PCV-10 in the immunization program. A total of 9,827 IPD cases were identified from 2008-2013 when combining SINAN and IAL databases. Overall, PCV-10 types decreased by 41.3% after PCV-10 vaccination period, mostly in children aged 2-23 months, while additional PCV-13 serotypes increased by 62.8% mainly in children under 5-year of age. For children aged 2-23 months, targeted by the immunization program, we observed a 44.2% (95%CI, 15.8-72.5%) reduction in IPD rates. In contrast, significant increase in IPD rates were observed for adults aged 18-39 y (18.9%, 95%CI 1.1-36.7%), 40-64 y (52.5%, 95%CI 24.8-80.3%), and elderly ≥ 65 y (79.3%, 95%CI 62.1-96.5%). This is the first report of a time-series analysis for PCV impact in IPD conducted at national level data in a developing country. We were able to show significant impact of PCV-10 on IPD for age groups targeted by vaccination in Brazil, 3 y after its introduction. No impact on other age groups was demonstrated.

Keywords: Streptococcus pneumoniae; data linkage; impact; interrupted time-series analysis; invasive pneumococcal disease; meningitis; pneumococcal vaccines; surveillance.

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Figures

Figure 1.
Figure 1.
Number of invasive pneumococcal disease by year according to vaccine serotypes and age group. Brazil, 2008 to 2013.
Figure 2.
Figure 2.
Observed (black and red) and predicted (blue) bimonthly rates of IPD by age group. Brazil, 2008 to 2013. IPD, invasive pneumococcal disease.
See this image and copyright information in PMC

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