Evaluation of impact of 23 valent pneumococcal polysaccharide vaccine following 7 valent pneumococcal conjugate vaccine in Australian Indigenous children |
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| Affiliation: | 1. National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead, Australia;2. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia;3. School of Public Health and Community Medicine, University of New South Wales, Australia;4. Telethon Kids Institute, the University of Western Australia, Perth, Western Australia, Australia;5. Centre for Disease Control, Department of Health, Northern Territory, Australia;6. Communicable Disease Control Directorate, Department of Health, Western Australia, Australia;7. School of Public Health, University of Sydney, Sydney, Australia;1. Protein Sciences Corporation, Meriden, CT, United States;2. Yale University School of Medicine, New Haven, CT, United States;3. University of Colorado Denver School of Medicine, Aurora, CO, United States;4. Biologics Consulting Group, Inc., Bethesda, MD, United States;1. State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510230, China;2. Dongguan Institute of Pediatrics, Dongguan Children''s Hospital, Dongguan 523325, China;3. School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, China;1. Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada;2. University of Toronto, 155 College Street, Toronto, ON, Canada;3. Canadian Center for Vaccinology, Dalhousie University, 6299 South Street, Halifax, NS, Canada;4. QE II Health Sciences Centre, Nova Scotia Health Authority, 1276 South Park Street, Halifax, NS, Canada;5. IWK Health Centre, Nova Scotia Health Authority, 5980 University Avenue, Halifax, NS, Canada;1. Hunter Medical Research Institute, University of Newcastle, Private Bag 10, Wallsend, Newcastle, 2287 NSW, Australia;2. Hunter New England Population Health, Private Bag 10, Wallsend, Newcastle, 2287 NSW, Australia |
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| Abstract: | ![]()
BackgroundHigh incidence and serotype diversity of invasive pneumococcal disease (IPD) in Indigenous children in remote Australia led to rapid introduction of 7-valent conjugate pneumococcal vaccine (7vPCV) at 2, 4 and 6 months in 2001, followed by 23-valent polysaccharide pneumococcal vaccine (23vPPV) in the second year of life. All other Australian children were offered 3 doses of 7vPCV without a booster from 2005. This study evaluated the impact of the unique pneumococcal vaccine schedule of 7vPCV followed by the 23vPPV booster among Indigenous Australian children.MethodsChanges in IPD incidence derived from population-based passive laboratory surveillance in Indigenous children <5 years eligible for 23vPPV were compared to non-Indigenous eligible for 7vPCV only from the pre-vaccine introduction period (Indigenous 1994–2000; non-Indigenous 2002–2004) to the post-vaccine period (2008–2010 in both groups) using incidence rate ratios (IRRs) stratified by age into serotype groupings of vaccine (7v and 13vPCV and 23vPPV) and non-vaccine types. Vaccine coverage was assessed from the Australian Childhood Immunisation Register.ResultsAt baseline, total IPD incidence per 100,000 was 216 (n = 230) in Indigenous versus 55 (n = 1993) in non-Indigenous children. In 2008–2010, IRRs for 7vPCV type IPD were 0.03 in both groups, but for 23v-non7v type IPD 1.2 (95% CI 0.8–1.8) in Indigenous versus 3.1 (95% CI 2.5–3.7) in non-Indigenous, difference driven primarily by serotype 19A IPD (IRR 0.6 in Indigenous versus 4.3 in non-Indigenous). For non-7vPCV type IPD overall, IRR was significantly higher in those age-eligible for 23vPPV booster compared to those younger, but in both age groups was lower than for non-Indigenous children.ConclusionThese ecologic data suggest a possible “serotype replacement sparing” effect of 23vPPV following 7vPCV priming, especially for serotype 19A with supportive evidence from other immunogenicity and carriage studies. Applicability post 10vPCV or 13v PCV priming in similar settings would depend on local serotype distribution of IPD. |
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| Keywords: | Pneumococcal disease Pneumococcal polysaccharide vaccine Pneumococcal conjugate vaccine Indigenous Invasive pneumococcal disease epidemiology |
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