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. 2025 Apr;25(4):445-456.
doi: 10.1016/S1473-3099(24)00588-7. Epub 2024 Dec 17.

Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis

Maria Garcia Quesada  1 Meagan E Peterson  2 Julia C Bennett  2 Kyla Hayford  2 Scott L Zeger  2 Yangyupei Yang  2 Marissa K Hetrich  2 Daniel R Feikin  3 Adam L Cohen  3 Anne von Gottberg  4 Mark van der Linden  5 Nina M van Sorge  6 Lucia H de Oliveira  7 Sara de Miguel  8 Inci Yildirim  9 Didrik F Vestrheim  10 Jennifer R Verani  11 Emmanuelle Varon  12 Palle Valentiner-Branth  13 Georgina Tzanakaki  14 Nadja Sinkovec Zorko  15 Lena P Setchanova  16 Fatima Serhan  3 Kevin J Scott  17 J Anthony Scott  18 Camelia Savulescu  19 Larisa Savrasova  20 Rita Reyburn  21 Kazunori Oishi  22 J Pekka Nuorti  23 Daniela Napoli  24 Jason M Mwenda  25 Carmen Muñoz-Almagro  26 Eva Morfeldt  27 Kimberley McMahon  28 Allison McGeer  29 Lucia Mad'arová  30 Grant A Mackenzie  31 Maria Eugenia León  32 Shamez N Ladhani  33 Karl G Kristinsson  34 Jana Kozakova  35 Jackie Kleynhans  36 Nicola P Klein  37 James D Kellner  38 Sanjay Jayasinghe  39 Pak-Leung Ho  40 Markus Hilty  41 Marcella A Harker-Jones  42 Laura L Hammitt  43 Marta Grgic-Vitek  15 Charlotte Gilkison  44 Ryan Gierke  45 Neil French  46 Idrissa Diawara  47 Stefanie Desmet  48 Philippe De Wals  49 Tine Dalby  50 Ron Dagan  51 Mary Corcoran  52 Edoardo Colzani  53 Grettel Chanto Chacón  54 Jesús Castilla  55 Romina Camilli  56 Michelle Ang  57 Krow Ampofo  58 Samanta C G Almeida  59 Pedro Alarcon  60 Katherine L O'Brien  61 Maria Deloria Knoll  2 PSERENADE Team
Collaborators, Affiliations

Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis

Maria Garcia Quesada et al. Lancet Infect Dis. 2025 Apr.

Erratum in

Abstract

Background: Widespread use of pneumococcal conjugate vaccines (PCVs) has reduced vaccine-type invasive pneumococcal disease (IPD). We describe the serotype distribution of IPD after extensive use of ten-valent PCV (PCV10; Synflorix, GSK) and 13-valent PCV (PCV13; Prevenar 13, Pfizer) globally.

Methods: IPD data were obtained from surveillance sites participating in the WHO-commissioned Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project that exclusively used PCV10 or PCV13 (hereafter PCV10 and PCV13 sites, respectively) in their national immunisation programmes and had primary series uptake of at least 70%. Serotype distribution was estimated for IPD cases occurring 5 years or more after PCV10 or PCV13 introduction (ie, the mature period when the serotype distribution had stabilised) using multinomial Dirichlet regression, stratified by PCV product and age group (<5 years, 5-17 years, 18-49 years, and ≥50 years).

Findings: The analysis included cases occurring primarily between 2015 and 2018 from 42 PCV13 sites (63 362 cases) and 12 PCV10 sites (6806 cases) in 41 countries. Sites were mostly high income (36 [67%] of 54) and used three-dose or four-dose booster schedules (44 [81%]). At PCV10 sites, PCV10 serotypes caused 10·0% (95% CI 6·3-12·9) of IPD cases in children younger than 5 years and 15·5% (13·4-19·3) of cases in adults aged 50 years or older, while PCV13 serotypes caused 52·1% (49·2-65·4) and 45·6% (40·0-50·0), respectively. At PCV13 sites, PCV13 serotypes caused 26·4% (21·3-30·0) of IPD cases in children younger than 5 years and 29·5% (27·5-33·0) of cases in adults aged 50 years or older. The leading serotype at PCV10 sites was 19A in children younger than 5 years (30·6% [95% CI 18·2-43·1]) and adults aged 50 years or older (14·8% [11·9-17·8]). Serotype 3 was a top-ranked serotype, causing about 9% of cases in children younger than 5 years and 14% in adults aged 50 years or older at both PCV10 and PCV13 sites. Across all age and PCV10 or PCV13 strata, the proportion of IPD targeted by higher-valency PCVs beyond PCV13 was 4·1-9·7% for PCV15, 13·5-36·0% for PCV20, 29·9-53·8% for PCV21, 15·6-42·0% for PCV24, and 31·5-50·1% for PCV25. All top-ten ranked non-PCV13 serotypes are included in at least one higher-valency PCV.

Interpretation: The proportion of IPD due to serotypes included in PCVs in use was low in mature PCV10 and PCV13 settings. Serotype distribution differed between PCV10 and PCV13 sites and age groups. Higher-valency PCVs target most remaining IPD and are expected to extend impact.

Funding: Bill & Melinda Gates Foundation as part of the WHO Pneumococcal Vaccines Technical Coordination Project.

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Conflict of interest statement

Declaration of interests MDK reports grants from Merck and Pfizer and personal fees from Merck. KH reports employment at Pfizer from Oct 26, 2020. AvG reports funding from Pfizer and attendance at advisory board meetings for Pfizer and Merck. MvdL reports support, membership of advisory boards, and speakers honoraria from Pfizer and Merck. NMvS reports speaker and service fees from MSD and GSK, and holding a patent (WO 2013/020090 A3) with royalties paid to herself and to the University of California San Diego (inventors: Nina van Sorge and Victor Nizet). IY reports membership of an mRNA-1273 study group, and funding to her institution from BioFire, MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Novavax, Sanofi Pasteur, and Micron. EV reports grants from the French Public Health Agency, Pfizer, and Merck. JAS reports grants from the Bill & Melinda Gates Foundation, the Wellcome Trust, the UK Medical Research Council, and the National Institute for Health and Care Research. CM-A reports grants from Pfizer and speaker fees from Pfizer and MSD. AM reports research support to her institution from Pfizer and Merck, and honoraria for advisory board membership from GSK, Merck, and Pfizer. SNL reports contract research for GSK, Pfizer, and Sanofi Pasteur on behalf of St George's University of London, with no personal remuneration. NPK reports research support from Pfizer, GSK, Sanofi Pasteur, Merck, and Protein Sciences (now Sanofi Pasteur). JDK reports an unrestricted grant-in-aid from Pfizer Canada. MH reports reimbursement for advisory boards from MSD; and an investigator-initiated research grant paid to his institution from Pfizer. LLH reports research grants to her institution from GSK, Pfizer, and Merck. SD reports a grant from Pfizer. RD reports grants and research support from Pfizer, MSD, and MedImmune; consultancy for Pfizer, MeMed, MSD, BiondVax, and GSK; participation on advisory boards for Pfizer, MSD, BiondVax, and GXRD; and having been a speaker for Pfizer, AstraZeneca, and GSK. MC reports a professional fee, an unrestricted research grant, and an Investigator Initiated Reward (W1243730) from Pfizer Ireland. KA reports a grant from Merck. SCGA reports a travel grant from Pfizer. KGK reports grants from GSK. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Sites that contributed IPD data to the PSERENADE project and reasons for exclusion from analysis IB-VPD=WHO Global Invasive Bacterial Vaccine-Preventable Diseases Laboratory Network. IPD=invasive pneumococcal disease. PCV=pneumococcal conjugate vaccine. PCV10=ten-valent PCV (Synflorix, GSK). PCV13=13-valent PCV (Prevenar 13, Pfizer). SIREVA=Pan American Health Organization Regional System for Vaccines.
Figure 2
Figure 2
Proportion of IPD cases in the mature PCV10 or PCV13 period due to serotypes included in current and upcoming products The tops of the bars indicate weighted means, with error bars representing 95% CIs. Serotype 3 is illustrated separately from other vaccine-type serotypes for products that include serotype 3 due to the uncertain effectiveness of current products against serotype 3. Serotype 6C is illustrated above the bars for products containing serotype 6A but not 6C as evidence suggests possible cross-protection against serotype 6C from 6A; serotype 6C was not included in estimation of the weighted means and 95% CIs (except for PCV25, the only vaccine in which it is included). Serotypes covered by each vaccine are shown in appendix 2 (p 10); higher-valency vaccines include most serotypes of lower-valency vaccines. IPD=invasive pneumococcal disease. PCV=pneumococcal conjugate vaccine. PCV10=ten-valent PCV (Synflorix, GSK). PCV13=13-valent PCV (Prevenar 13, Pfizer). PCV15=15-valent PCV (VAXNEUVANCE, Merck). PCV20=20-valent PCV (Prevenar 20, Pfizer). PCV21=21-valent PCV (V116 and CAPVAXIVE, Merck). PCV24=24-valent PCVs (GSK, Vaxcyte, and Merck). PCV25=25-valent PCV (IVT PCV-25, Inventprise). PPV23=23-valent pneumococcal polysaccharide vaccine.
Figure 3
Figure 3
Serotype-specific distribution of IPD cases in the mature PCV10 or PCV13 period The tops of the bars indicate weighted means, with error bars representing 95% CIs. Serotypes are coloured by the lowest-valency PCV product in which they are included. The “x” in the key represents the extra serotypes included in that product relative to the next lower-valency product (eg, PCV13x includes serotypes 3, 6A, and 19A, which are not in PCV10). The only exception is PCV25x—not all serotypes in PCV24 are in PCV25, so PCV25x represents multiple serotypes that are in PCV25 but not PCV24 (see appendix 2 p 10 for differences in coverage). Serotype 6C is shown separately because, although it is not included in most products (except PCV25), it is potentially covered through cross-protection with PCV13-type serotype 6A. PCV21, which excludes nine PCV10 types, is not shown here (appendix 2 p 26), but other types covered by PCV21 include 23A, 23B, and 31. Serotypes 15B and 15C were grouped as 15BC as described in Methods. IPD=invasive pneumococcal disease. PCV=pneumococcal conjugate vaccine. PCV10=ten-valent PCV (Synflorix, GSK). PCV13=13-valent PCV (Prevenar 13, Pfizer). PCV15=15-valent PCV (VAXNEUVANCE, Merck). PCV20=20-valent PCV (Prevenar 20, Pfizer). PCV21=21-valent PCV (V116 and CAPVAXIVE, Merck). PCV24=24-valent PCVs (GSK, Vaxcyte, and Merck). PCV25=25-valent PCV (IVT PCV-25, Inventprise). PPV23=23-valent pneumococcal polysaccharide vaccine.
Figure 4
Figure 4
Site-specific proportions of IPD cases in the mature PCV10 or PCV13 period due to serotypes included in current and upcoming products Each site is represented by a dot, coloured by region and sized proportionally to the number of cases contributed by that site. Box plots indicate medians with IQRs for the site-specific percentages. The modelled weighted means shown in figure 2 are shown here by red diamonds. Sites with fewer than five cases are not shown but were included in the modelled and box plot estimates. Data from Singapore are not shown for confidentiality but contributed to the PCV13 modelled results. IPD=invasive pneumococcal disease. PCV=pneumococcal conjugate vaccine. PCV10=ten-valent PCV (Synflorix, GSK). PCV13=13-valent PCV (Prevenar 13, Pfizer). PCV15=15-valent PCV (VAXNEUVANCE, Merck). PCV20=20-valent PCV (Prevenar 20, Pfizer). PCV21=21-valent PCV (V116 and CAPVAXIVE, Merck). PCV24=24-valent PCVs (GSK, Vaxcyte, and Merck). PCV25=25-valent PCV (IVT PCV-25, Inventprise). PPV23=23-valent pneumococcal polysaccharide vaccine.

References

    1. GBD 2019 Antimicrobial Resistance Collaborators Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400:2221–2248. - PMC - PubMed
    1. Johnson HL, Deloria-Knoll M, Levine OS, et al. Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: the Pneumococcal Global Serotype project. PLoS Med. 2010;7 - PMC - PubMed
    1. International Vaccine Access Center. Johns Hopkins Bloomberg School of Public Health VIEW-hub by IVAC: pneumococcal conjugate vaccine (PCV) access and coverage. https://view-hub.org/vaccine/pcv/access
    1. WHO Pneumococcal conjugate vaccine for childhood immunization—WHO position paper. Wkly Epidemiol Rec. 2007;82:93–104. - PubMed
    1. Cherian T, Cohen M, de Oliveira L, et al. Pneumococcal Conjugate Vaccine (PCV) Review of Impact Evidence (PRIME): summary of findings from systematic review. 2017. https://terrance.who.int/mediacentre/data/sage/SAGE_Docs_Ppt_Oct2017/9_s...

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