Incidence of Pneumococcal Disease Due to Non-Pneumococcal Conjugate Vaccine (PCV7) Serotypes in the United States during the Era of Widespread PCV7 Vaccination, 1998–2004

Johns Hopkins University, Baltimore, Maryland, United States
The Journal of Infectious Diseases (Impact Factor: 5.78). 11/2007; 196(9):1346-54. DOI: 10.1086/521626
Source: PubMed

ABSTRACT Widespread use of pneumococcal conjugate vaccine (PCV7) resulted in decreases in invasive disease among children and elderly persons. The benefits may be offset by increases in disease due to serotypes not included in the vaccine (hereafter, "nonvaccine serotypes"). We evaluated the effect of PCV7 on incidence of disease due to nonvaccine serotypes.
Cases of invasive disease were identified in 8 geographic areas through the Centers for Disease Control and Prevention's Active Bacterial Core surveillance. Serotyping and susceptibility testing of isolates were performed. We calculated the incidence of disease for children aged <5 years and adults aged > or =65 years. We compared rates of serotype-specific disease before and after PCV7 was licensed for use.
The annual incidence of disease due to nonvaccine serotypes increased from an average of 16.3 cases/100,000 population during prevaccine years (1998-1999) to 19.9 cases/100,000 population in 2004 for children aged <5 years (P=.01) and from 27.0 cases/100,000 population during prevaccine years to 29.8 cases/100,000 population in 2004 for adults aged > or =65 years (P=.05). Significant increases in the incidences of disease due to serotypes 3, 15, 19A, 22F, and 33F were observed among children during this period (P<.05 for each serotype); serotype 19A has become the predominant cause of invasive disease in children. The incidence of disease due to these serotypes also increased among elderly persons.
The incidence of pneumococcal disease caused by nonvaccine serotypes is increasing. Ongoing surveillance is needed to monitor the magnitude of disease caused by nonvaccine serotypes, to ensure that future vaccines target the appropriate serotypes.

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    • "Our survey showed improvement of the drug susceptibility profile of S. pneumoniae after introduction of PCV7 in Japan. There have already been reports that PCV7 decreases the rate of invasive pneumococcal disease, such as meningitis, sepsis, and pneumonia [20]. In the Northern California Kaiser Permanente (NCKP) Trial, total AOM episodes decreased by 7% in the vaccinated group, while the decrease was 6% in the Finnish Otitis Media (FinOM) Vaccine Trial [23] [24]. "
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    • "The selection of serotypes included in the 7-, 10-, and 13- valent pneumococcal conjugate vaccines (PCVs) is based upon the frequency with which these serotypes caused invasive pneumococcal disease (IPD) prior to conjugate vaccine introduction, with the aim to maximally reduce the frequency of pneumococcal disease. Although the introduction of the pneumococcal conjugate vaccines in national vaccination schemes has reduced the incidence of pneumococcal disease caused by the vaccine serotypes [3], non-vaccine serotypes are increasingly being isolated from both pediatric and adult patients with IPD [4] [5] [6]. Also in The Netherlands serotype replacement has been observed following the introduction of PCV7 in the National Pediatric Vaccination Program in 2006 [7]. "
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