7价肺炎球菌结合疫苗的效果评价

目的探讨接种7价肺炎球菌结合疫苗(PCV7)预防肺炎球菌肺炎和重症肺炎的效果。方法用回顾性队列法,选取本市拱北辖区接种了PCV7的≥3月龄且5岁儿童为PCV7组,未接种的为非PCV7组。调查两组的肺炎球菌肺炎和重症肺炎的发病情况。结果 PCV7组2 213人,肺炎球菌肺炎63例(2.9%),重症肺炎5例(0.2%);非PCV7组7 059人,肺炎球菌肺炎274例(3.9%),重症肺炎59例(0.8%)。PCV7组肺炎球菌肺炎发病率和重症肺炎发病率均较低。PCV7组对非PCV7组,肺炎球菌肺炎发病率和重症肺炎发病率比较,疫苗效率(VE)分别为27.4%和73.1%。PCV7组中,按标准免疫程序接种115人,肺炎球菌肺炎1人,发病率0.9%,无重症肺炎,补充免疫接种2 098人,肺炎球菌肺炎62人,发病率3.0%,重症肺炎5人(0.2%)。结论接种PCV7疫苗的肺炎和重症肺炎的保护效果好,尤其是对重症肺炎保护效果更好,肺炎发病率和重症肺炎的发病率都较低。     

接种13价肺炎球菌结合疫苗对就诊儿童肺炎链球菌血清型和耐药性的影响

目的  了解就诊儿童肺炎链球菌(Streptococcus pneumoniae, Spn)血清型分布和耐药特征,探索接种13价肺炎球菌结合疫苗(13-valent pneumococcal conjugate vaccine, PCV13)对Spn的影响。方法  收集2017—2019年苏州大学附属儿童医院疫苗接种信息明确的就诊儿童的Spn菌株,根据疫苗接种情况进行分组,并采用荚膜肿胀法进行血清分型,E-test法检测菌株抗生素的耐药性,比较是否接种PCV13对Spn血清型和耐药性的差别。结果  共收集692株Spn,其中20株分离自接种PCV13儿童。接种组中常见的血清型为19F、6B、19A、23F,对照组中常见的血清型为19F、6B、23F、19A、14,两组血清型分布差别无统计学意义(P=0.868),PCV13血清型覆盖率分别为70.0% 和72.4%(P=0.491)。所有菌株对红霉素、四环素、克林霉素高度耐药,且多重耐药率达98.5%。接种组和对照组的Spn菌株对青霉素的不敏感率分别为5.0%和9.1%(P=0.804)。结论  苏州大学附属儿童医院监测就诊儿童Spn血清型以PCV13覆盖的血清型为主,菌株对β-内酰胺类抗生素的耐药性有所下降,但对红霉素等其他常用抗菌药物的耐药性依旧严峻,并存在大量的多重耐药情况。尚未观察到接种PCV13对菌株血清型分布及降低抗生素耐药性的明显效果。     

7价肺炎球菌多糖结合疫苗对全球肺炎球菌疾病的影响

肺炎球菌疾病是全球的严重公共健康问题之一,据世界卫生组织2008年估算,全球约有47.6万例〈5岁儿童死于肺炎球菌疾病。目前临床治疗过程中,抗生素治疗是首选。但随着抗生素的广泛使用,肺炎球菌耐药日趋严峻,因此,采用疫苗预防的必要性日益凸显。2000年全球首个可用于〈2岁儿童的7价肺炎球菌多糖结合疫苗（7-valent Pneumococcal Polysaccharide Conjugate Vaccine,PPCV7）在美国获批使用。现就PPCV7应用10多年来对全球肺炎球菌疾病的影响进行综述。结果表明,及早主动接种PPCV7进行预防,可有效降低侵袭性肺炎球菌疾病、社区获得性肺炎和中耳炎等的发病率和死亡率。同时,PPCV7可覆盖大部分耐药肺炎球菌的感染,其保护作用在婴儿期基础免疫后至少可持续2-3年,甚至更长。在流行性感冒（流感）大流行时期,PPCV7显著降低流感相关肺炎的住院率,且PPCV7在免疫缺陷等高危人群中效果显著。另外,当PPCV7接种率达到一定水平,其保护效果表现出更广泛的群体免疫效应,使全人群获益。     

7价肺炎球菌结合疫苗（沛儿TM）用于健康中国儿童加强免疫的安全性和免疫原性

目的评价已接种3剂7价肺炎球菌结合疫苗（7-Valent Peneumococcal Conjugate Vaccine,PCV7）的健康中国儿童,使用PCV,进行加强免疫的安全性和免疫原性。方法488名中国婴儿在3、4、5月龄接种3剂PCV,后,于12～15月龄时用PCV,加强免疫,接种3剂PCV,的婴儿分为与白喉-破伤风-无细胞百日咳联合疫苗分开接种（第1组）或同时接种（第2组）两组。加强免疫后,对每名受试者进行30d的随访,以观察疫苗的安全性。加强免疫前及加强免疫后30d时,从部分受试者抽取血样,以测定加强免疫的免疫原性。结果PCV,加强免疫后,第1组和第2组分别有89％和91％的受试者体温正常。其局部反应通常为轻度反应。两组受试者每种血清型接种后／接种前抗体几何平均浓度增加的差异均具有非常显著的统计学意义（P〈0．0001）。结论PCV,加强免疫对中国健康儿童具有良好的安全性,并能诱发加强免疫应答。     

七价肺炎链球菌结合疫苗治疗肺炎链球菌性疾病的成本-效果分析

目的:对七价肺炎链球菌结合疫苗预防肺炎链球菌性疾病开展药物经济学分析。方法:构建Markov模型,结合北京、广州、深圳和武汉的成本数据和台湾健保局的流行病学数据,对将PCV7纳入国家免疫规划方案进行5年的模拟。结果:成本效果分析得出,免疫规划方案实施5年内,可避免11 793人死亡、获得42 265.49QALYs,并节约成本1 574.7元/每人。与不实施免疫规划方案相比较,实施规划为绝对优势方案。结论:将PCV7纳入国家免疫规划方案具有成本效果,并且随着接种率的提高,该方案将产生更大的净效益。     

7价肺炎球菌多糖结合疫苗在广东省5个市使用的安全性监测分析

目的分析7价肺炎球菌多糖结合疫苗（7-valent Pneumococcal Polysaccharide Conjugate Vaccine,PCV,）上市后大规模人群应用的被动监测结果,评价PCV7的安全性。方法通过疑似预防接种异常反应（Adverse Event Following Immunization,AEFI）信息管理系统,收集广东省珠江三角洲（珠三角）地区广州、深圳、东莞、中山、佛山5个市2009～2011年接种PCV7报告的AEFI个案,采用描述性流行病学方法分析相关信息。结果5个市共接种PCV,24．86万剂,报告AEFI196例,报告发生率78．85/10万剂。报告一般反应102例,报告发生率41．04110万剂：其中发热84例,报告发生率33．79/10万剂：局部红肿10例,报告发生率4．02/10万剂;异常反应73例,报告发生率29．37/10万剂;其中过敏性皮疹70例,报告发生率28．16/10万剂;热性惊厥2例,报告发生率0～80/10万剂;过敏性紫癜1例,报告发生率0．40/10万剂。97．96％的个案发生在接种后≤3d。结论现有的PCV,被动监测数据未发现不同于其他疫苗的不良反应。     

七价肺炎球菌结合疫苗的安全性监测评价

[目的]评价七价肺炎球菌结合疫苗的安全性。[方法]2010年10～11月对215名到济南市中心医院预防接种门诊接种七价肺炎球菌结合疫苗者,年龄为3个月至3岁的婴幼儿进行七价肺炎球菌结合疫苗(沛儿prevenar)接种后不良反应的临床观察,分别于接种疫苗后30min和12、24、48、72h观察不良反应,直至不良反应消失。[结果]共观察215名婴幼儿,19人(占8.84%)发生不良反应,共23例次,不良反应发生率为8.84%。3个月至1岁11个月组接种112人,发生不良反应的10人,不良反应发生率8.93%;2～3岁组接种103人,发生不良反应的9人,不良反应发生率为8.74%,二者差异无统计学意义(P>0.05)。局部反应为14例次,全身反应为9例次,均于对症治疗3日内缓解、消失。[结论]临床观察证明接种七价肺炎球菌结合疫苗有较好的安全性。     

657名学龄前儿童肺炎链球菌带菌率调查

肺炎链球菌是临床常见的致病菌,也较常在儿童鼻咽部定植,组成正常菌群的一部分。儿童带菌与感染关系密切,为了解杭州地区学龄前儿童不同月份肺炎链球菌的带菌状况,遂在2002年3月至2003年6月(暑假除外)对杭州市某甲级幼儿园的托幼儿童进行了调查。 1.材料与方法: (1)标本来源:研究对象为2～5岁儿童657名,其中男性339人,女性318人。应用带转运培养基的咽拭子(法国bioMériex公司),每周1次进行咽拭子培养,标本采集由专人完成,每次采样1个班,接种工作在3h内完成。对肺炎链球     

婴幼儿不同部位接种7价肺炎球菌结合疫苗不良反应发生情况比较及分析

肺炎链球菌是导致婴幼儿脑膜炎、菌血症及肺炎等严重疾病的首位病原菌,也是引起鼻窦炎、急性中耳炎（AOM）的最常见病因[1].接种肺炎球菌疫苗是最经济有效的预防措施.目前我国已经上市的有7价肺炎球菌结合疫苗（PCV7）和23价肺炎链球菌多糖疫苗（PPV23）,PPV23适用于2岁以上人群,对2岁以下的儿童只能使用PCV7进行保护.据文献报道,国内PCV7（接种部位未报告）的不良反应发生率为5.27％～10.83％,高于其他二类疫苗[2-4].根据儿童肺炎链球菌性疾病防治技术指南（2009年版）[5]推荐,PCV7接种部位首选为婴儿的腿前外侧区域（股外侧肌）或儿童上臂三角肌,因此,比较股外侧肌和上臂三角肌两个不同接种部位不良反应的发生情况,可为减少婴幼儿PCV7接种后的不良反应提供依据.     

Ten years of experience with the pneumococcal conjugate 7-valent vaccine in children

In children, pneumococcus became the predominant infectious agent, after the routine use of the Hib conjugate vaccine dramatically decreased Haemophilus Influenzae type b prevalence. The incidence of invasive pneumococcal infections (IPI) and of non-invasive infections due to vaccine serotypes (VS) decreased by 80% in Europe along with a 30–40% decrease in the global incidence of IPI in this age group, after the implementation of Prevenar 7^® routine immunization in children below 2 years of age. The decrease of IPI due to VS in other age groups was an indirect benefit. The moderate increase of non-vaccinal serotype IPI incidence did not impede the benefit of the overall program. Serotype 19A was the most frequent and carried resistance to antibiotics. Prevenar 13^®, a second-generation vaccine with six new serotypes, replaced Prevenar 7^® in most countries after 2010, with available evidence of its effectiveness (United Kingdom, US, France).     

Long-term impact of pneumococcal polysaccharide vaccination on nasopharyngeal carriage in children previously vaccinated with various pneumococcal conjugate vaccine regimes

Previously, the Fiji Pneumococcal Project (FiPP) evaluated reduced dose immunization schedules that incorporated pneumococcal protein conjugate and/or polysaccharide vaccine (PCV7 and 23vPPV, respectively). Immune hyporesponsiveness was observed in children vaccinated with 23vPPV at 12 months of age compared with children who did not receive 23vPPV.Here we assess the long-term impact of 23vPPV vaccination on nasopharyngeal carriage rates and densities of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and Moraxella catarrhalis. Nasopharyngeal swabs (n = 194) were obtained from healthy children who participated in FiPP (now aged 5–7 years). S. pneumoniae were isolated and identified by standard culture-based methods, and serotyped using latex agglutination and the Quellung reaction. Carriage rates and densities of S. pneumoniae, H. influenzae, S. aureus and M. catarrhalis were determined using real-time quantitative PCR.There were no differences in the rate or density of S. pneumoniae, H. influenzae or M. catarrhalis carriage by PCV7 dose or 23vPPV vaccination in the vaccinated participants overall. However, differences were observed between the two main ethnic groups: Fijian children of Indian descent (Indo-Fijian) were less likely to carry S. pneumoniae, H. influenzae and M. catarrhalis, and there was evidence of a higher carriage rate of S. aureus compared with indigenous Fijian (iTaukei) children. Polysaccharide vaccination appeared to have effects that varied between ethnic groups, with 23vPPV vaccination associated with a higher carriage rate of S. aureus in iTaukei children, while there was a lower carriage rate of S. pneumoniae associated with 23vPPV vaccination in Indo-Fijian children.Overall, polysaccharide vaccination had no long-term impact on pneumococcal carriage, but may have impacted on S. aureus carriage and have varying effects in ethnic groups, suggesting current WHO vaccine schedule recommendations against the use of 23vPPV in children under two years of age are appropriate.     

Impact of the 13-valent pneumococcal conjugate vaccine on Streptococcus pneumoniae multiple serotype carriage

IntroductionPneumococcal multiple serotype carriage is important for evolution of the species and to understand how the pneumococcal population is changing with vaccination. We aimed to determine the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on multiple serotype carriage.Methods and materialsNasopharyngeal samples from fully vaccinated pneumococcal carriers (4 doses of PCV13, n = 141, aged 18–72 months) or from non-vaccinated pneumococcal carriers (0 doses of any PCV, n = 140, same age group) were analyzed. Multiple serotype carriage was evaluated by DNA hybridization with a molecular serotyping microarray that detects all known serotypes.ResultsVaccinated children had a lower prevalence of multiple serotype carriage than the non-vaccinated group (20.6% vs 29.3%, p = 0.097), and a significantly lower proportion of PCV13 serotypes (6.4% vs 38.5%, p = 0.0001). PCV13 serotypes found among vaccinated children were mostly detected as a minor serotype in co-colonization with a more abundant non-vaccine serotype. Vaccinated children were colonized by a significantly higher proportion of commensal non-pneumococcal Streptococcus spp. (58.2% vs 42.8%, p = 0.012). In vaccinated children there were significantly less non-vaccine type (NVT) co-colonization events than expected based on the distribution of these serotypes in non-vaccinated children.ConclusionsThe results suggest that vaccinated children have lower pneumococcal multiple serotype carriage prevalence due to higher competitive abilities of non-vaccine serotypes expanding after PCV13 use. This might represent an additional benefit of PCV13, as decreased co-colonization rates translate into decreased opportunities for horizontal gene transfer and might have implications for the evolution and virulence of pneumococci.     

Impact of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on childhood pneumonia hospitalizations in Brazil two years after introduction

Introduction

Pneumococcal disease is a major public health problem worldwide. From March to September of 2010, 10-valent pneumococcal non-typeable Haemophilus influenzae protein conjugate vaccine (PHiD-CV) was introduced in the Brazilian childhood National Immunization Program (NIP) in all 27 Brazilian states. The aim of the present study is to report national time-trends in incidence of hospital admissions for childhood pneumonia in Brazil before and after two years of introduction of this new pneumococcal conjugate vaccine.

Methods

Analysis of hospitalization data of children aged 0–4 years in Brazilian public health system with an admission diagnosis of pneumonia from 2002 to 2012 was performed comparing pre (2002–2009) and post-vaccination periods (2011–2012). Hospital number of admission due to pneumonia and all non-respiratory diseases were obtained from DATASUS, the Brazilian government open-access public health database system. Incidence of pneumonia hospitalization was compared to incidence of all non-respiratory admissions.

Results

Admission rates for pneumonia decreased steadily from 2010 to 2012. In children aged less than four years, incidence of pneumonia hospitalizations decreased 12.65% when pre (2002–2009) and post-vaccination introduction periods (2011–2012) were compared and adjusted for seasonality and secular-trend (p < 0.001). On the other hand, non-respiratory admission rates remained stable comparing both periods (p = 0.39).

Conclusion

Childhood pneumonia hospitalization rates were fluctuating prior to 2010 and decreased significantly in the two years after PHiD-CV introduction. Conversely, rate of non-respiratory admissions has shown no decrease. These data are an evidence of the effectiveness and public health impact of this new pneumococcal vaccine.     

Nasopharyngeal carriage of Streptococcus pneumoniae and other bacteria in the 7th year after implementation of the pneumococcal conjugate vaccine in the Netherlands

After introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the infant national immunization program (NIP) in the Netherlands in 2006, Streptococcus pneumoniae strains of the non-vaccine serotype 19A emerged and became the dominant serotype in carriage in children and their parents. Similar patterns were observed in other European countries and the United States. Increases in carriage rates of Staphylococcus aureus and non-typeable (NT) Haemophilus influenzae were also observed. After switching of PCV7 to 10-valent vaccine (PCV10) in 2011, a new carriage surveillance study was performed in the winter of 2012/2013. Nasopharyngeal carriage of S. pneumoniae, H. influenzae, S. aureus, and Moraxella catarrhalis was determined by conventional culture in 330 PCV10-vaccinated 11-month-old children, 330 PCV7-vaccinated 24-month-old children, and their parents. Carriage prevalence was compared with similar carriage studies conducted in 2005, 2009, and 2010/2011. Although serotype 19A remained the most frequently carried pneumococcal serotype in children, prevalence of 19A significantly declined in PCV7-vaccinated 24-month-old children (14% to 8%, p = 0.01), but less in PCV10-vaccinated 11-month-old children (12% to 9%, p = 0.31). Carriage of H. influenzae remained stable at an elevated level (65% in 11-month-olds and 69% in 24-month-olds), while the carriage of S. aureus returned to pre-PCV7 levels in 11-month-old children (14% in 2010/2011 to 7% in 2012/2013), but not in 24-month-olds (remained at 7%). Our results might indicate a new balance between replacing non-vaccine pneumococcal serotypes and other potential pathogenic bacteria in nasopharyngeal carriage. Carriage studies are valuable tools in assessing vaccine effects on pathogens circulating in the population, for evaluation of PCV impact, and in predicting changes in respiratory and invasive disease.     

Pneumococcal carriage in children in Ulaanbaatar,Mongolia before and one year after the introduction of the 13-valent pneumococcal conjugate vaccine

BackgroundNasopharyngeal carriage of Streptococcus pneumoniae precedes disease, is the source of pneumococcal community spread, and the mechanism for herd protection provided by pneumococcal conjugate vaccines (PCVs). There are few PCV impact studies in low- and middle-income countries, particularly in Asia. In 2016, Mongolia introduced the 13-valent PCV (PCV13) in a phased manner using a 2 + 1 schedule, with catch-up. We aimed to assess the impact of PCV13 introduction on nasopharyngeal pneumococcal carriage and density in children in Mongolia.MethodsWe conducted two cross-sectional carriage surveys (pre- and one year post-PCV) at community health clinics in two districts of the capital city, Ulaanbaatar in both May-July 2015 and 2017. The study analysis included 961 children too young to be vaccinated (5–8 weeks old) and 989 children eligible for vaccination (12–23 months old). Pneumococci were detected by quantitative real-time PCR and molecular serotyping performed using DNA microarray.FindingsOne year post-PCV introduction, PCV13 serotype carriage reduced by 52% in 12–23 month olds (adjusted prevalence ratio [aPR] 0.48 [95% confidence interval [CI] 0.39–0.59]), with evidence of non-PCV13 serotype replacement (aPR 1.55 [95% CI 1.30–1.85]), compared with the pre-PCV period. In 5–8 week olds, PCV13 serotype carriage reduced by 51% (aPR 0.49 [95% CI 0.33–0.73]) with no significant change in non-PCV13 serotype carriage (aPR 1.10 [95% CI 0.83–1.46]). An increase was observed in both PCV13 and non-PCV13 pneumococcal density post-PCV introduction. Antimicrobial resistance (AMR) genes were common, with 82.3% of samples containing at least one of the 10 AMR genes assessed.ConclusionThis study demonstrates substantive PCV13 impact on pneumococcal carriage one year post-vaccine introduction in Mongolia. The reductions in PCV13 serotype carriage are likely to result in reductions in pneumococcal disease including indirect effects. Increases in non-PCV13 serotypes require further monitoring.     

Dynamics of pneumococcal carriage among day-care center attendees during the transition from the 7-valent to the higher-valent pneumococcal conjugate vaccines in Greece

Background

In Greece recently, higher-valent pneumococcal conjugate vaccines (PCVs) replaced the 7-valent (PCV7); the 10-valent (PCV10) became available in May 2009 and the 13-valent (PCV13) in June 2010.

Methods

We investigated the nasopharyngeal colonization with Streptococcus pneumoniae in day-care center attendees in Athens and the prefecture of Viotia. Between December 2010 and June 2011, nasopharyngeal cultures were obtained 4 times, at enrollment and then every 6 to 8 weeks.

Results

Among the 233 children, 225 (96.6%) had been vaccinated with ≥1 dose of PCV7. One tenth of the PCV7 vaccinated attendees had also received ≥1 dose of PCV13 or PCV10. During the 4 samplings, 358 isolates were recovered from a total of 874 samples. Of the 233 children, 183 (78.5%) were found to carry S. pneumoniae at least once. The overall serotype distribution among carriers was similar regardless of the time lapsed since the last PCV7 dose. A high frequency of 19A (17.1%) coincided with a low frequency of 19F (1.4%). Non-PCV13 serotypes accounted for 73.1% of the isolates; 23B, 15B/C, 16F, 21, 11A, 15A, 6C, 10A, 22F and 23A were the most common. Among attendees aged 24–59 months (median age 42 months), prolonged carriage of a non-PCV13 serotype was relatively common, mainly for 21 and 16F. One out of 4 cases of colonization with the prevalent non-PCV13 serotypes was followed by persistent carriage for 5 to 14 weeks.

Conclusions

During this period of transition to the higher-valent PCVs in the day-care center setting, non-PCV13 serotypes dominated and exhibited prolonged colonization. The frequency and the duration of prolonged carriage tends to be increased, if sampling frequency increases and the carriage time before and after positive cultures is taken into consideration. Further studies regarding the fitness of the colonizing non-PCV13 serotypes will likely to be seen in the future.     

Direct effect of the 13-valent pneumococcal conjugate vaccine use on pneumococcal colonization among children in Brazil

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) has been commercially available in Brazil since 2010. We investigated the carriage prevalence, capsular types, and antimicrobial resistance among pneumococci isolated from children immunized with PCV13 in Brazil.MethodsWe analyzed 500 children < 6 years old attending public (n = 270) and private (n = 230) clinics in Niterói/RJ, Brazil, in 2014. We determined the antimicrobial susceptibility and capsular types for all isolates.ResultsThirty-eight (7.6%) of 500 children had received at least one PCV13 dose. Since only two (0.7%) of 270 children at the public clinic were vaccinated with PCV13, major analyses focused on 36 (15.7%) of 230 children attending private clinics. Nine (25%) of 36 children were pneumococcal carriers. Characteristics associated with carriage were age ≥ 2 years, cough/expectoration, and childcare center attendance (p ≤ 0.01). The capsular types found were 15B/C (n = 2), 6C, 11A/D, 16F, 23A, and 23F. Two isolates were non-typeable (NT). Three (33.3%) isolates were multidrug resistant. We found four (44.4%) penicillin non-susceptible pneumococci, with penicillin and ceftriaxone MICs ranging from 0.12 to 4.0 µg/ml and 0.023–0.5 µg/ml, respectively. We also detected two (22.2%) erythromycin-resistant isolates (MICs of 3.0 and 256 µg/ml).ConclusionsColonization with PCV13 serotype was rare among the vaccinated children. Increasing PCV13 coverage might help reduce the frequency of major serotypes currently associated with invasive pneumococcal diseases in Brazil, such as 3 and 19A. The isolation of multidrug-resistant serotype 6C and NT isolates in carriage, however, requires close monitoring.     

Compared effectiveness of the 7-valent pneumococcal conjugate vaccine in children with the 13-valent vaccine in adults

13-valent-pneumococcal conjugated vaccine was recently approved in the USA and Europe for adults 50 years of age or more. But this approval was followed by recommendations limiting its use to immunocompromised and asplenic patients. The extension of indications to adults was based on the well-demonstrated clinical effectiveness in infants less than 2 years of age, and on a better immune response either quantitatively or qualitatively with conjugated vaccines compared to the immunogenicity of plain polysaccharide vaccines. Nevertheless, the issue was to know whether results observed with the 7-valent pneumococcal conjugate vaccine in children are reproducible in adults with the 13-valent. The answer was given by comparing the epidemiological and physiopathological data, and the immunological response of the two populations. Very few clinical effectiveness studies in adults are available. We had for aim to assess these various issues in infants and adults. A lot of questions remain, such as the unknown impact of serotype replacement with the 13-valent pneumococcal conjugated vaccine on the clinical epidemiology and emergent Streptococcus pneumoniae pathogenicity, while waiting for the CAPITA study results expected in 2014.