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. 2017 Feb 16;12(2):e0172222.
doi: 10.1371/journal.pone.0172222. eCollection 2017.

Effect of the different 13-valent pneumococcal conjugate vaccination uptakes on the invasive pneumococcal disease in children: Analysis of a hospital-based and population-based surveillance study in Madrid, Spain, 2007-2015

Juan Picazo  1 , Jesús Ruiz-Contreras  2   3 , Juan Casado-Flores  4   5 , Sagrario Negreira  2   3 , Fernando Baquero  5   6 , Teresa Hernández-Sampelayo  3   7 , Enrique Otheo  8 , Cristina Méndez  9 ; Heracles Study Group
Affiliations

Effect of the different 13-valent pneumococcal conjugate vaccination uptakes on the invasive pneumococcal disease in children: Analysis of a hospital-based and population-based surveillance study in Madrid, Spain, 2007-2015

Juan Picazo et al. PLoS One. .

Abstract

In the Community of Madrid, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent (PCV7) in the fully government-funded Regional Immunization Program (RIP) in May, 2010, but was later excluded in May, 2012, and included again in January, 2015. These unique changes allowed us to assess the impact of the different pneumococcal vaccination policies on PCV13 uptake in infants and on the incidence rate (IR) of invasive pneumococcal disease (IPD) in children <15 years old. In this prospective, active, surveillance study, we estimated PCV13 uptakes, IR and incidence rate ratios (IRR) for total IPD and for IPD caused by PCV13- and non-PCV13 serotypes in children <15 years, stratified by age, in four periods with different vaccination policies: fully government-funded PCV7 vaccination, fully government-funded PCV13, mixed public/private funding and only private funding. Vaccine uptakes reached 95% in periods with public-funded pneumococcal vaccination, but fell to 67% in the private funding period. Overall, IR of IPD decreased by 68% (p<0.001) in 2014-15, due to 93% reduction in the IR of PCV13-type IPD (p<0.001) without significant changes in non-PCV13-type IPD. A fully government-funded PCV13 vaccination program lead to high vaccine uptake and dramatic reductions in both overall and PCV13-type IPD IR. When this program was switched to private PCV13 vaccination, there was a fall in vaccine coverage and stagnation in the decline of PCV13-type IPD with data suggesting a weakening of herd immunity.

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Conflict of interest statement

Competing Interests: J.P. reports grants and non-financial support from Pfizer S.L.U., Madrid, Spain during the conduct of the study, grants and non-financial support from Pfizer S.L.U., Madrid, Spain, and grants from GSK, Madrid, Spain, outside the submitted work. J.R-C. reports personal fees from Pfizer S.L.U., Madrid, Spain, during the conduct of the study, and grants from Pfizer S.L.U., Madrid, Spain, outside the submitted work. J.C-F., S.N., E.O. and T.H-S. report grants from Pfizer S.L.U., Madrid, Spain during the conduct of the study. F.B. has nothing to disclose C.M. reports grants from Pfizer S.L.U., Madrid, Spain, during the conduct of the study; and is an employee of Pfizer S.L.U., Madrid, Spain. This does not alter our adherence to PLOS ONE policies on sharing data and materials if there is a previous authorization by the corresponding hospital(s).

Figures

Fig 1
Fig 1. Incidence rates.
Incidence rate (IR) of invasive pneumococcal disease in total (all children <15 years old) and in the different age groups. Percentages of vaccine coverage are shown as dotted lines. Data from 2007 to 2012 have been previously reported (references 13–17).
Fig 2
Fig 2. Evolution of cases of invasive pneumococcal disease (IPD) caused by serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13).
Estimated evolution of PCV13-type IPD in relation to PCV13 introduction using the Holt-Winters exponential smoothing.
See this image and copyright information in PMC

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