Differences in the impact of pneumococcal serotype replacement in individuals with and without underlying medical conditions

Daniel M. Weinberger*, Joshua L. Warren, Tine Dalby, Eugene D. Shapiro, Palle Valentiner-Branth, Hans Christian Slotved, Zitta Barrella Harboe

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

Abstract

Background. Pneumococcal conjugate vaccines (PCVs) have had a well-documented impact on the incidence of invasive pneumococcal disease (IPD). However, declines in IPD due to vaccine-targeted serotypes have been partially offset by increases in IPD due to nonvaccine serotypes (NVTs). The goal of this study was to quantify serotype-specific changes in the incidence of IPD that occurred in different age groups, with or without certain comorbidities, following the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood vaccination program in Denmark. Methods. We used nationwide surveillance data for IPD and a hierarchical Bayesian regression framework to estimate changes in the incidence of IPD associated with the introduction of PCV7 (2007) and PCV13 (2010) while controlling for serotype-specific epidemic cycles and unrelated secular trends. Results. Following the introduction of PCV7 and PCV13 in children, the net impact of serotype replacement varied considerably by age group and comorbidities. Differences in the magnitude of serotype replacement were due to variations in the incidence of NVTs in the different risk groups before the introduction of PCVs. The relative increases in the incidence of IPD caused by specific NVTs did not differ appreciably between risk groups in the postvaccination period. Serotype replacement offset a greater proportion of the benefit of PCVs in strata in which the NVTs comprised a larger proportion of cases prior to the introduction of the vaccines. Conclusions. These findings could help to predict the impact of next-generation PCVs in specific risk groups.

Original languageEnglish
JournalClinical Infectious Diseases
Volume69
Issue number1
Pages (from-to)100-106
Number of pages7
ISSN1058-4838
DOIs
Publication statusPublished - 18 Jun 2019
Externally publishedYes

Bibliographical note

Funding Information:
and R56AI110449 to D. M. W.). Support was also received from the Bill & Melinda Gates Foundation (award numbers OPP1176267 and OPP1114733); the National Institute on Aging (grant number P30AG021342; Scholar at the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine to D. M. W.); and the National Center for Advancing Translational Science, components of NIH and the NIH Roadmap for Medical Research (grant numbers UL1TR001863, UL1 TR000142, and KL2 TR000140).

Funding Information:
Potential conflicts of interest. D. M. W. has received consulting fees from Pfizer, Merck, GlaxoSmithKline, and Affinivax. Z. B. H. has received travel grants and consultancy fees from Pfizer and GSK. D. M. W. and Z. B. H. have received support from the Robert Austrian Research Award in Pneumococcal Vaccinology, which is supported by Pfizer. H. C. S. is participating in a Pfizer-sponsored project. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Funding Information:
Financial support. This work was funded by the National Institute of Allergy and Infectious Diseases, NIH (grant numbers R01AI123208

Funding Information:
This work was funded by the National Institute of Allergy and Infectious Diseases, NIH (grant numbers R01AI123208 and R56AI110449 to D. M. W.). Support was also received from the Bill & Melinda Gates Foundation (award numbers OPP1176267 and OPP1114733); the National Institute on Aging (grant number P30AG021342; Scholar at the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine to D. M. W.); and the National Center for Advancing Translational Science, components of NIH and the NIH Roadmap for Medical Research (grant numbers UL1TR001863, UL1 TR000142, and KL2 TR000140).

Publisher Copyright:
© The Author(s) 2018.

Keywords

  • Bayesian hierarchical model
  • Conjugate vaccines
  • Pneumococcus
  • Serotype replacement

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