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Assessing the Impact of Pneumococcal Conjugate Vaccine Immunization Schedule Change From 3+0 to 2+1 in Australian
Sanjay Jayasinghe1,2, Phoebe C M Williams1,3,4, Kristine K Macartney1,2
1National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Childrens Hospital Network, Westmead, New South Wales, Australia.
Insights
Australia
Area of Science:
- Epidemiology
- Immunization
- Public Health
Background:
- The Australian childhood immunization schedule for the 13-valent pneumococcal conjugate vaccine (PCV13) was modified in mid-2018.
- The schedule shifted from a 3+0 (three primary doses) to a 2+1 (two primary doses and one booster) regimen.
- This change aimed to reduce breakthrough invasive pneumococcal disease (IPD) cases, particularly in children over 12 months old.
Purpose of the Study:
- To evaluate the effectiveness of the 2+1 PCV13 schedule compared to the previous 3+0 schedule.
- To assess the impact of the schedule change on IPD incidence and serotype distribution in Australian children.
- To provide evidence for informing future vaccination strategies.
Main Methods:
- Utilized national invasive pneumococcal disease (IPD) surveillance data from 2012 to 2022.
- Compared IPD cases before and after the schedule change, analyzing age groups, serotypes, and clinical presentations.
- Employed time-series modeling to compare observed IPD rates with expected rates under the continued 3+0 schedule.
Main Results:
- The 2+1 schedule was associated with a 51.7% reduction in IPD caused by vaccine-type serotypes compared to the 3+0 schedule.
- Serotype 3 emerged as the predominant breakthrough serotype, while serotype 19A decreased.
- Bacteremic pneumonia was the most common clinical manifestation (69%), with meningitis being rare (3%-4%).
Conclusions:
- The 2+1 PCV13 schedule demonstrates superior effectiveness in controlling overall IPD compared to the 3+0 schedule.
- This finding supports the adoption of the 2+1 schedule for countries utilizing 3+0 PCV schedules.
- The shift in predominant serotypes warrants continued surveillance and potential vaccine updates.
Background:
In mid-2018, the Australian childhood 13-valent pneumococcal conjugate vaccine schedule changed from 3+0 to 2+1, moving the third dose to 12 months of age, to address increasing breakthrough cases of invasive pneumococcal disease (IPD), predominantly in children aged >12 months. This study assessed the impact of this change using national IPD surveillance data.
Methods:
Pre- and postschedule change 3-dose 13-valent pneumococcal conjugate vaccine breakthrough cases were compared by age group, serotype, and clinical syndrome. Annual rates of breakthrough cases were calculated (per 100 000) using respective birth cohort sizes and 3-dose vaccine coverage. Using time-series modelling, observed IPD rates in children aged <12 years were compared to that expected if the 3+0 schedule were continued.
Findings:
Over 2012-2022, rate of 3-dose breakthrough cases in children aged >12 months was 2.8 per 100 000 (n = 557; 11 birth cohorts). Serotype 3 replaced 19A as predominant breakthrough serotype (respectively, 24% and 65% in 2013 to 60% and 20% in 2022) followed by 19F. In breakthrough cases, the most frequent clinical phenotype was bacteremic pneumonia (69%), with meningitis accounting for 3%-4%. In cohorts eligible for 2+1 versus 3+0 schedules, rate of breakthrough cases was lower for all vaccine serotypes, except type 3 (incidence rate ratio, 0.50 [95% confidence interval, .28-.84] and 1.12 [0.71-1.76], respectively). Observed compared to expected IPD was 51.7% lower (95% confidence interval, -60.9 to -40.7%) for vaccine serotypes, but the change for nonvaccine types was not significant 12% (-9.6 to 39.7).
Interpretations:
The 2+1 schedule is likely superior to 3+0 for overall IPD control, a finding that may be worth consideration for other countries considering or using 3+0 PCV schedules.
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