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. 2023 Feb 8;76(3):e1062-e1070.
doi: 10.1093/cid/ciac475.

Distribution of Serotypes Causing Invasive Pneumococcal Disease in Children From High-Income Countries and the Impact of Pediatric Pneumococcal Vaccination

Lindsay R Grant  1 , Mary P E Slack  2 , Christian Theilacker  3 , Jelena Vojicic  4 , Stephane Dion  4 , Ralf-Rene Reinert  5 , Luis Jodar  1 , Bradford D Gessner  1
Affiliations

Distribution of Serotypes Causing Invasive Pneumococcal Disease in Children From High-Income Countries and the Impact of Pediatric Pneumococcal Vaccination

Lindsay R Grant et al. Clin Infect Dis. .

Abstract

Background: The introduction and adoption of pneumococcal conjugate vaccines (PCVs) into pediatric national immunization programs (NIPs) has led to large decreases in invasive pneumococcal disease (IPD) incidence caused by vaccine serotypes. Despite these reductions, the global IPD burden in children remains significant.

Methods: We collected serotype-specific IPD data from surveillance systems or hospital networks of all 30 high-income countries that met inclusion criteria. Data sources included online databases, surveillance system reports, and peer-reviewed literature. Percentage of serotyped cases covered were calculated for all countries combined and by PCV type in the pediatric NIP.

Results: We identified 8012 serotyped IPD cases in children <5 or ≤5 years old. PCV13 serotype IPD caused 37.4% of total IPD cases, including 57.1% and 25.2% for countries with PCV10 or PCV13 in the pediatric NIP, respectively, most commonly due to serotypes 3 and 19A (11.4% and 13.3%, respectively, across all countries). In PCV10 countries, PCV15 and PCV20 would cover an additional 45.1% and 55.6% of IPD beyond serotypes contained in PCV10, largely due to coverage of serotype 19A. In PCV13 countries, PCV15 and PCV20 would cover an additional 10.6% and 38.2% of IPD beyond serotypes contained in PCV13. The most common IPD serotypes covered by higher valency PCVs were 10A (5.2%), 12F (5.1%), and 22F and 33F (3.5% each).

Conclusions: Much of the remaining IPD burden is due to serotypes included in PCV15 and PCV20. The inclusion of these next generation PCVs into existing pediatric NIPs may further reduce the incidence of childhood IPD.

Keywords: streptococcus pneumoniae; children; invasive pneumococcal disease; pneumococcal conjugate vaccines; serotype distribution.

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Conflict of interest statement

Potential conflicts of interest. L. G., C. T., J. V., S. D., R. R., L. J., and B. G. are employees of Pfizer Inc and may hold Pfizer Inc stock or stock options. L. G., C. T., J. V., and B. G. report stock options with Pfizer. S. D. reports owning Pfizer stock as Pfizer Canada ULC employee. J. V. reports receipt of medical writing support from ICON and support for attending meetings and/or travel from Pfizer Inc, as per regular business needs. R. R. and L. J. report stock and stock options with Pfizer. M. S. has received personal fees and honoraria from GSK (presentations at international meetings), Pfizer, AstraZeneca (honoraria for chairing an advisory board) and Sanofi Pasteur (honoraria for attending advisory board) and Merck (honoraria for attending advisory board) as a speaker at international meetings and as a member of advisory boards (outside the scope of the submitted work), and support paid to author to attend international meetings from GSK and Pfizer. She has also worked as a contractor for Pfizer. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Characteristics of countries meeting inclusion criteria for analysis. an = 38 excluded due to no surveillance system or hospital network reporting IPD cases. bn = 2 excluded (Taiwan and Portugal). cn = 1 excluded (Croatia). dn = 9 excluded (Cyprus, Estonia, Greece, Iceland, Luxembourg, Latvia, Lithuania, Malta, and Switzerland). Abbreviations: IPD, invasive pneumococcal disease; NIP, national immunization program; PCV, pneumococcal conjugate vaccine.
Figure 2.
Figure 2.
Percentages of cases caused by vaccine-specific serotypes (PCV serotype coverage) among countries with PCV10 and PCV13 use in children <5 years old. n represents the number of cases reported in each country. *Estimates of PCV20 coverage for children <5 years old are weighted averages of the <1- and 1–4-year data. For full details and source data, see Supplementary Table 2. Abbreviations: PCV, pneumococcal conjugate vaccine; PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PCV15, 15-valent pneumococcal conjugate vaccine; PCV20, 20-valent pneumococcal conjugate vaccine.
Figure 3.
Figure 3.
PCV13 coverage versus the incremental coverage of PCV15 or PCV20 beyond PCV13 coverage (A) and beyond PCV10 coverage (B). Abbreviations: PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PCV15, 15-valent pneumococcal conjugate vaccine; PCV20, 20-valent pneumococcal conjugate vaccine.
Figure 4.
Figure 4.
PCV serotype coverage, by type of PCV in the pediatric NIP (A) and absolute incremental increase in PCV serotype coverage, by type pf PCV in the pediatric NIP (B). Arrows show absolute incremental increase in PCV serotype coverage among sequential PCV formulations. Abbreviations: NIP, national immunization program; PCV, pneumococcal conjugate vaccine; PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PCV15, 15-valent pneumococcal conjugate vaccine; PCV20, 20-valent pneumococcal conjugate vaccine.
Figure 5.
Figure 5.
Percentages of IPD cases caused by vaccine-specific serotypes (PCV serotype coverage) by duration of PCV use (A) and duration of PCV use and WHO region (B). Abbreviations: AMRO, Regional Office for the Americas; EMRO, Regional Office for the Eastern Mediterranean; EURO, Regional Office for Europe; IPD, invasive pneumococcal disease; PCV, pneumococcal conjugate vaccine; PCV10, 10-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PCV15, 15-valent pneumococcal conjugate vaccine; PCV20, 20-valent pneumococcal conjugate vaccine; WHO, Word Health Organization; WPRO, Regional Office for the Western Pacific.
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