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. 2020 Mar;145(3):e20190836.
doi: 10.1542/peds.2019-0836. Epub 2020 Feb 13.

Pneumococcal Conjugate Vaccine Breakthrough Infections: 2001-2016

Tolulope A Adebanjo  1   2 , Tracy Pondo  1 , David Yankey  2 , Holly A Hill  2 , Ryan Gierke  1 , Mirasol Apostol  3 , Meghan Barnes  4 , Susan Petit  5 , Monica Farley  6 , Lee H Harrison  7 , Corinne Holtzman  8 , Joan Baumbach  9 , Nancy Bennett  10 , Suzanne McGuire  11 , Ann Thomas  12 , William Schaffner  13 , Bernard Beall  2 , Cynthia G Whitney  2 , Tamara Pilishvili  14
Affiliations

Pneumococcal Conjugate Vaccine Breakthrough Infections: 2001-2016

Tolulope A Adebanjo et al. Pediatrics. 2020 Mar.

Abstract

Background: Most countries use 3-dose pneumococcal conjugate vaccine (PCV) schedules; a 4-dose (3 primary and 1 booster) schedule is licensed for US infants. We evaluated the invasive pneumococcal disease (IPD) breakthrough infection incidence in children receiving 2 vs 3 primary PCV doses with and without booster doses (2 + 1 vs 3 + 1; 2 + 0 vs 3 + 0).

Methods: We used 2001-2016 Active Bacterial Core surveillance data to identify breakthrough infections (vaccine-type IPD in children receiving ≥1 7-valent pneumococcal conjugate vaccine [PCV7] or 13-valent pneumococcal conjugate vaccine [PCV13] dose) among children aged <5 years. We estimated schedule-specific IPD incidence rates (IRs) per 100 000 person-years and compared incidence by schedule (2 + 1 vs 3 + 1; 2 + 0 vs 3 + 0) using rate differences (RDs) and incidence rate ratios.

Results: We identified 71 PCV7 and 49 PCV13 breakthrough infections among children receiving a schedule of interest. PCV13 breakthrough infection rates were higher in children aged <1 year receiving the 2 + 0 (IR: 7.8) vs 3 + 0 (IR: 0.6) schedule (incidence rate ratio: 12.9; 95% confidence interval: 4.1-40.4); PCV7 results were similar. Differences in PCV13 breakthrough infection rates by schedule in children aged <1 year were larger in 2010-2011 (2 + 0 IR: 18.6; 3 + 0 IR: 1.4; RD: 16.6) vs 2012-2016 (2 + 0 IR: 3.6; 3 + 0 IR: 0.2; RD: 3.4). No differences between schedules were detected in children aged ≥1 year for PCV13 breakthrough infections.

Conclusions: Fewer PCV breakthrough infections occurred in the first year of life with 3 primary doses. Differences in breakthrough infection rates by schedule decreased as vaccine serotypes decreased in circulation.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Harrison has received fees from GlaxoSmithKline, Merck, Pfizer, and Sanofi Pasteur for consulting on the epidemiology and vaccine prevention of bacterial diseases; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Cases included in analysis of PCV7 and PCV13 breakthrough infections, ABCs, 2001–2016. a A PCV7 breakthrough infection is defined as vaccine-type IPD in a child who received ≥1 PCV7 dose. A PCV13 breakthrough infection is defined as vaccine-type IPD in a child who received ≥1 PCV13 dose.
FIGURE 2
FIGURE 2
A, PCV7 breakthrough infections among children aged <5 years with verified vaccination histories by calendar year and vaccine schedule, ABCs, 2001–2016. B, PCV13 breakthrough infections among children aged <5 years with verified vaccination histories by calendar year and vaccine schedule, ABCs, 2010–2016.
FIGURE 3
FIGURE 3
IR (cases per 100 000 person-years) of PCV13 breakthrough infections in the first year of life among children receiving a 2 + 0 vs 3 + 0 schedule based on verified and imputed vaccination histories. Rates for 2010–2011 based on verified vaccination histories only (ie, without imputing vaccine history) are the same as imputed rates. Rates for 2012–2016 by using verified vaccination histories only (ie, without imputing vaccine history) are as follows: 2 + 0 = 2.9; 3 + 0 = 0.2; RD = 2.7.
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References

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