Indirect effect of infant PCV10/13 vaccination on IPD in the elderly: pooled analysis from 13 EU sites

This project has received funding

from the European Union’s Horizon 2020

research and innovation programme

under grant agreement No 634446

Germaine Hanquet, Camelia Savulescu and SpIDnet / I-MOVE + group

ESCAIDE, Stockholm, 29 November 2016

SpIDnet in persons ≥65 years

Aim

To assess the indirect effect of infant PCV10/13 on elderly IPD

To inform decisions on pneumococcal vaccination of elderly

Method

Comparison post PCV10/13 period vs. pre-PCV10/13:

Incidence rate ratio (IRR) of each PCV10/13 year (2011-15) Compared to the last pre-PCV10/13 year (2009)

IRR per site, serotype group and vaccination year

Meta-analysis of IRR from 13 sites, using random effects Heterogeneity assessed

Stratified by vaccination policy

Imputing for missing serotypes and sensitivity

Overall IPD in persons ≥65 years, 2000-15

PCV10/13

CAT: Catalonia FI: Finland MAD: Madrid NOR: NorwayCZ: Czech Republic FR: France NL: the Netherlands DK: DenmarkEW: England & Wales IE: Ireland NAV: Navarra SC: Scotland

Ratio of IPD incidence in ≥65 years post-PCV10/13compared to 2009, 13 sites

-9%

-77%-39%

+63%

No further decline in overall IPD in 2015

-14%

Ratio of IPD incidence in ≥65 years post-PCV10/13compared to 2009, PCV types

-73%

-20%

+1%

PCV10 PCV7 + 1, 5 and 7F

PCV13 PCV10 + 3, 6A and 19A

-18%

Serotypes 3 and 19A: 12 sites

Ratio of IPD incidence in ≥65 years post-PCV10/13compared to 2009, non-PCV types

+50%

+64%

PPV23 unique types: increase in every site: from +30% to +200% in 2015

*: serotypes not in PPV23 nor in PCV13

Ratio of IPD incidence in ≥65 years post-PCV10/13compared to 2009, by vaccine policy

Larger reduction on overall IPD in sites with PCV13 universal policy

-16%

-85%

+50%

-51%

-78%

-1%

+83%+19%

FR, DK, NO, E&W, SC, IE NL, FI, CZ (PCV10/13), SE (PCV10/13)

Ratio of IPD incidence in ≥65 years post-PCV10/13compared to 2009, PCV types and by vaccine policy

Large 19A increase in 2015, in the 3 PCV10 sites (IRR 2-5)

→ cross protection of PCV10 on serotype 19A not seen in indirect effect

-77%

-38% -40%-11%

+50%

-53%

+227%+58%

PCV13 and PPV23 serotypes in 2015

PCV13 serotypes PPV23 serotypes not in PCV13

-32% -6%

DiscussionSummary

Limited net effect of infant PCV10/13 on overall IPD in elderly

Reduction in PCV13 types partly countered by non-PCV13 gradual rises

Effect declined in 2015, as incidence rose in every site

Different effect in PCV13 / PCV10 universal sites

PCV10 sites: lower PCV13 decline, due to 3 and 19A rises

→ remaining PCV13 disease varies according to vaccine policy

Increase of PPV23nonPCV13 serotypes in every site

Assumptions and limitations

Pre and post-PCV population, epidemiology and surveillance did not change

Heterogeneity across sites: random effect and stratified analysis

Conclusions and recommendations

Potential benefit of PCV13 in elderly reduced by indirect effect of infant vaccination:

Remaining PCV13 disease declines rapidly

Increase of PPV23 additional type incidence with time

Additional benefit of adult PCV13/PPV23 vaccination over the indirect effect of infant vaccination?

Differs with infant vaccination policy and history

Indirect effect to take into account in decision making

Needs to further monitor serotype trends Non-PCV13 types

19A and 3 in PCV10 countries

SpIDnet / I-MOVE+ pneumo teamsAt the surveillance sites: Professionals from participating hospitals and laboratories in each site

Czech Republic: P. Krizova, J. Kozakova, H. Sebestova, M. Maly

Denmark: P. Valentiner-Branth, L. Espenhain, T. Dalby, Z. Harboe, HC Slotved, VF. de Casadevante, K. Fuursted

France: A. Lepoutre, E. Belchior, C. Levy, R. Cohen, E. Varon, M.C. Ploy, J. Gaillat, D. Levy‐Bruhl

Finland: H Rinta-Kokko, J. Jokinen, P. Nuorti

Ireland: J. Mereckiene, S. Cotter, M.A. Fitzgerald, M. Corcoran, R. Cunney, H. Humphries

Netherlands: M. Knol, L. Mollema, A. Van der Ende, W. van der Hoek, G. Berbers, H. de Melker, E. Sanders

Norway: D. Vestrheim, B. Winje, M. Bergsaker

Romania: M. Pana, D. Craciun, I. Codita, V. Alexandrescu

Sweden: B. Henriques Normark, E. Morfeldt, J. Darenberg, T. Lepp, A. Lindstrand

Scotland, UK: E. McDonald, A. Smith Palmer, C. Cameron, A. Smith, B. Denham, B. Jones, J. McMenamin

England and Wales, UK: S. Ladhani, S. Collins, N. Fry

Spain: M. Viarce Torres (national level)

• Catalonia: P. Ciruela, C. Izquierdo, C. Muñoz‐Almagro, S. Broner, R. Pallarés

• Madrid: L. Garcia, P. Latasa, J. Carlos Sanz, M. Ordobas

• Navarre: M. Guevara, J. Castilla, C. Ezpeleta, A. Gil-Setas

At the ECDC: L. Pastore Celentano, R. Whittaker

At the coordination: C. Savulescu (c.savulescu@epiconcept.fr), G. Hanquet, M. Valenciano, A. Moren – EpiConcept