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. 2024 Sep;9(9):e654-e663.
doi: 10.1016/S2468-2667(24)00161-0. Epub 2024 Aug 14.

Potential impact of replacing the 13-valent pneumococcal conjugate vaccine with 15-valent or 20-valent pneumococcal conjugate vaccine in the 1 + 1 infant schedule in England: a modelling study

Yoon Hong Choi  1 , Marta Bertran  2 , David J Litt  3 , Shamez N Ladhani  4 , Elizabeth Miller  5
Affiliations
Free article

Potential impact of replacing the 13-valent pneumococcal conjugate vaccine with 15-valent or 20-valent pneumococcal conjugate vaccine in the 1 + 1 infant schedule in England: a modelling study

Yoon Hong Choi et al. Lancet Public Health. 2024 Sep.
Free article

Abstract

Background: Paediatric pneumococcal conjugate vaccine (PCV) programmes in England using seven-valent PCV (PCV7) in 2006 and 13-valent PCV (PCV13) in 2010 have reduced vaccine-type invasive pneumococcal disease, but the overall effect has been reduced by an increase in invasive pneumococcal disease due to non-vaccine serotypes and serotype 3. We developed pneumococcal transmission models to investigate the potential effect on invasive pneumococcal disease of higher valency PCVs covering an additional two (ie, 15-valent PCV [PCV15]) or seven serotypes (ie, 20-valent PCV [PCV20]) in England.

Methods: We conducted a modelling study using realistic, age-structured, and compartmental deterministic models fitted to carriage data from before the introduction of PCVs and invasive pneumococcal disease data from before and after the introduction of PCV7 and PCV13 in England from the UK Heath Security Agency invasive pneumococcal disease surveillance system. We estimated key parameters, including PCV7 and PCV13 efficacy against vaccine-type carriage and invasiveness of PCV7 serotypes; the additional serotypes in PCV13, PCV15 and PCV20; and non-vaccine serotypes. We simulated the effect of transitioning from PCV13 to PCV15 or PCV20 in infants under the current 1 + 1 vaccination schedule and investigated the effect of reduced carriage protection against PCV13 serotypes due to attenuation of immunogenicity in higher valency vaccines.

Findings: Our results suggest that PCV15 might increase overall invasive pneumococcal disease as the reduction in vaccine-type invasive pneumococcal disease would be counterbalanced by an increase in non-PCV15 invasive pneumococcal disease. By contrast, PCV20 is projected to have a substantial impact on overall invasive pneumococcal disease due to higher invasiveness of the additional serotypes covered by PCV20 than the replacing non-vaccine serotypes. Reduced carriage protection against PCV13 serotypes with higher valency vaccines would amplify these effects.

Interpretation: Replacing PCV13 with PCV20 is likely to have a substantial public health benefit, but PCV15 could potentially increase the overall burden of disease.

Funding: UK Health Security Agency and National Institute of Health Research.

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Conflict of interest statement

Declaration of interests The Immunisation and Vaccine Preventable Diseases Division of the UK Health Security Agency provides vaccine manufacturers with post-marketing surveillance reports on pneumococcal and meningococcal infections, which the companies are required to submit to the Medicines and Healthcare Products Regulatory Agency in compliance with the companies' risk management strategy. A cost recovery charge is made for these reports. SNL performs contract research on behalf of St George's University of London and the UK Health Security Agency for pharmaceutical companies but receives no personal remuneration. The Respiratory and Vaccine Preventable Bacteria Reference Unit of the UK Health Security Agency has received grant funding from vaccine manufacturers for investigator-led research projects on pneumococcal surveillance. EM receives support from the National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (Grant Reference NIHR200929). All other authors declare no competing interests.

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