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Rapid reduction in invasive pneumococcal disease after introduction of PCV7 into the National Immunization Plan in
S Ben-Shimol1, D Greenberg, N Givon-Lavi
1The Pediatric Infectious Disease Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
The 7-valent pneumococcal conjugate vaccine (PCV7) significantly reduced invasive pneumococcal disease (IPD) in Israeli children under 5. Surveillance showed no serotype replacement, with PCV13 expected to further decrease IPD rates.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- Israel introduced the 7-valent pneumococcal conjugate vaccine (PCV7) into its National Immunization Program (NIP) in July 2009.
- Nationwide active prospective surveillance for invasive pneumococcal disease (IPD) in children has been ongoing since 1989.
Purpose of the Study:
- To evaluate the epidemiology of IPD in children under 5 years old.
- To assess the impact of PCV7 introduction on IPD incidence and serotype distribution.
- To analyze trends before and after PCV7 implementation.
Main Methods:
- Utilized a nationwide active prospective surveillance system for IPD in children.
- Collected monthly IPD case reports from all 27 centers performing blood/cerebrospinal fluid cultures in children.
- Employed a capture-recapture approach to ensure data completeness.
Main Results:
- PCV7 serotypes (7VST) accounted for approximately 50% of all IPD cases in children under 5.
- Following PCV7 introduction, 7VST IPD incidence decreased by 43% in 2009 and 81% in 2010 compared to the 2003-2007 average.
- Overall IPD incidence decreased by 23% in 2009 and 42% in 2010; no significant serotype replacement was observed.
- Serotype 6A dynamics mirrored 7VST, while other serotypes showed fluctuations without clear trends. Serotypes not in PCV13 remained stable.
Conclusions:
- Active, long-term surveillance demonstrated a rapid and significant decline in IPD in young children after PCV7 NIP initiation.
- No evidence of serotype replacement was detected during the study period.
- The transition to PCV13, initiated in October 2010, is anticipated to further reduce IPD, requiring continued follow-up.
Background:
The 7-valent conjugated vaccine (PCV7) was introduced into the Israeli National Immunization Program (NIP) in July 2009 (2, 4, 12 months schedule; 2 dose catch-up in second year of life). Nationwide active prospective surveillance on invasive pneumococcal disease (IPD) has been conducted in children since 1989. In the current study, IPD epidemiology in children <5 years during the 20 years before and 18 months after PCV7 NIP initiation, is reported.
Methods:
All 27 centers performing blood/cerebrospinal fluid (CSF) cultures in children reported monthly IPD cases. Capture-recapture approach was used for completeness.
Results:
During 1989-2010, 6022 IPD cases were reported in children <5 years; PCV7 serotypes (7VST) caused ∼50% of all episodes. In 2009 and 2010, 7VST IPD incidences <5 years of age (per 100,000) were 15.9 and 5.4, respectively (a 43% and 81% decrease, respectively) compared to 2003-2007 (mean incidence 27.8). Serotype 6A dynamics resembled those of 7VST. The respective overall IPD incidence decreases were 23% and 42%. The incidence dynamics of serotypes 1, 3, 5, 7F and 19A IPD were characterized by considerable fluctuations over the study period without any upwards or downwards trend in any of the age groups. The overall incidence of serotypes not included in the 13-valent pneumococcal conjugate vaccine (PCV13) did not vary significantly during the study period. By the end of 2010, 72% of the remaining IPD was caused by pneumococcal serotypes included in PCV13.
Conclusions:
An active prospective long-term surveillance, showed a rapid and sharp decline in IPD in children <5 years following initiation of NIP with PCV7. No serotype replacement has been observed so far. The transition from PCV7 to PCV13 initiated in October 2010 may lead to a further substantial decrease in IPD. Follow-up is needed to better determine the long-term PCV effects.
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