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Dose-specific Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-serotype Streptococcus pneumoniae Colonization in Children.
Clin Infect Dis. 2020 11 05; 71(8):e289-e300.CI

Abstract

BACKGROUND

Reduced-dose pneumococcal conjugate vaccine (PCV) schedules are under consideration in countries where children are recommended to receive 3 doses. Whereas PCV-derived protection against vaccine-serotype colonization is responsible for herd effects of vaccination, dose-specific PCV effectiveness against colonization endpoints is not known. We aimed to assess the performance of differing PCV schedules against vaccine-serotype colonization in children.

METHODS

From 2009-2016, we monitored pneumococcal carriage in southern Israel, where children should receive PCV at ages 2 months, 4 months, and 12 months (2 primary [p] +1 booster [b] schedule). We analyzed nasopharyngeal swabs and vaccination histories from 5928 children aged 0-59 months without symptoms of diseases potentially attributable to pneumococci. Matching individuals on age, sex, ethnicity, visit timing, and recent antibiotic receipt, we measured schedule-specific 7-valent PCV (PCV7) and 13-valent PCV (PCV13) effectiveness against vaccine-serotype colonization in a modified case-control framework. We sampled from the distribution of all possible case-control match assignments for statistical analyses.

RESULTS

Receiving 2 primary-series PCV13 doses conferred 53% (95% confidence interval [CI], 32-67%) protection against PCV13-serotype colonization at ages ≤12 months; 1 primary-series dose was not protective. A 2p+1b PCV13 series conferred 40% (95% CI, 4-67%) and 62% (95% CI, 33-83%) protection against PCV13-serotype colonization at ages 13-24 months and 25-59 months, respectively. Estimates suggested greater PCV13-conferred protection against PCV7-targeted serotypes than the 6 PCV13-only serotypes. As compared to children receiving 2p+1b PCV13 dosing, those receiving 1p+1b and 2p+0b schedules experienced 2.05-fold (95% CI, 1.12-5.00) and 3.33-fold (95% CI, 2.28-4.93) greater odds, respectively, of vaccine-serotype pneumococcal colonization at ages 13-24 months.

CONCLUSIONS

Our results demonstrate real-world effectiveness of 2p+1b PCV dosing against vaccine-serotype colonization. Reduced-dose schedules may confer lower protection against vaccine-serotype carriage during and beyond the first year of life.

Authors+Show Affiliations

Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA.Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel. Pediatric Infectious Disease Unit, Soroka University Medical Center, Be'er Sheva, Israel.Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31784753

Citation

Lewnard, Joseph A., et al. "Dose-specific Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-serotype Streptococcus Pneumoniae Colonization in Children." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 71, no. 8, 2020, pp. e289-e300.
Lewnard JA, Givon-Lavi N, Dagan R. Dose-specific Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-serotype Streptococcus pneumoniae Colonization in Children. Clin Infect Dis. 2020;71(8):e289-e300.
Lewnard, J. A., Givon-Lavi, N., & Dagan, R. (2020). Dose-specific Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-serotype Streptococcus pneumoniae Colonization in Children. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 71(8), e289-e300. https://doi.org/10.1093/cid/ciz1164
Lewnard JA, Givon-Lavi N, Dagan R. Dose-specific Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-serotype Streptococcus Pneumoniae Colonization in Children. Clin Infect Dis. 2020 11 5;71(8):e289-e300. PubMed PMID: 31784753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dose-specific Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines Against Vaccine-serotype Streptococcus pneumoniae Colonization in Children. AU - Lewnard,Joseph A, AU - Givon-Lavi,Noga, AU - Dagan,Ron, PY - 2019/07/18/received PY - 2019/11/28/accepted PY - 2019/12/1/pubmed PY - 2021/4/28/medline PY - 2019/12/1/entrez KW - Streptococcus pneumoniae KW - PCV KW - pneumococcal conjugate vaccine KW - vaccine effectiveness KW - vaccine schedule SP - e289 EP - e300 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 71 IS - 8 N2 - BACKGROUND: Reduced-dose pneumococcal conjugate vaccine (PCV) schedules are under consideration in countries where children are recommended to receive 3 doses. Whereas PCV-derived protection against vaccine-serotype colonization is responsible for herd effects of vaccination, dose-specific PCV effectiveness against colonization endpoints is not known. We aimed to assess the performance of differing PCV schedules against vaccine-serotype colonization in children. METHODS: From 2009-2016, we monitored pneumococcal carriage in southern Israel, where children should receive PCV at ages 2 months, 4 months, and 12 months (2 primary [p] +1 booster [b] schedule). We analyzed nasopharyngeal swabs and vaccination histories from 5928 children aged 0-59 months without symptoms of diseases potentially attributable to pneumococci. Matching individuals on age, sex, ethnicity, visit timing, and recent antibiotic receipt, we measured schedule-specific 7-valent PCV (PCV7) and 13-valent PCV (PCV13) effectiveness against vaccine-serotype colonization in a modified case-control framework. We sampled from the distribution of all possible case-control match assignments for statistical analyses. RESULTS: Receiving 2 primary-series PCV13 doses conferred 53% (95% confidence interval [CI], 32-67%) protection against PCV13-serotype colonization at ages ≤12 months; 1 primary-series dose was not protective. A 2p+1b PCV13 series conferred 40% (95% CI, 4-67%) and 62% (95% CI, 33-83%) protection against PCV13-serotype colonization at ages 13-24 months and 25-59 months, respectively. Estimates suggested greater PCV13-conferred protection against PCV7-targeted serotypes than the 6 PCV13-only serotypes. As compared to children receiving 2p+1b PCV13 dosing, those receiving 1p+1b and 2p+0b schedules experienced 2.05-fold (95% CI, 1.12-5.00) and 3.33-fold (95% CI, 2.28-4.93) greater odds, respectively, of vaccine-serotype pneumococcal colonization at ages 13-24 months. CONCLUSIONS: Our results demonstrate real-world effectiveness of 2p+1b PCV dosing against vaccine-serotype colonization. Reduced-dose schedules may confer lower protection against vaccine-serotype carriage during and beyond the first year of life. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/31784753/Dose_specific_Effectiveness_of_7__and_13_Valent_Pneumococcal_Conjugate_Vaccines_Against_Vaccine_serotype_Streptococcus_pneumoniae_Colonization_in_Children_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciz1164 DB - PRIME DP - Unbound Medicine ER -