title: Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study.
abstract: BACKGROUND
  In March 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10), which was licensed based on non-inferiority of immunological correlates of protection compared with the seven-valent vaccine. The schedule comprised three primary doses at ages 2 months, 4 months, and 6 months, and a booster dose at age 12 months. A single catch-up dose was offered for children aged 12-23 months at the time of introduction. We assessed PCV10 effectiveness against invasive pneumococcal disease in Brazilian children.
  
  
  METHODS
  Invasive pneumococcal disease, defined as isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid, or another normally sterile site, was identified in children age-eligible for at least one PCV10 dose through laboratory-based and hospital-based surveillance in ten states in Brazil from March 1, 2010, until Dec 31, 2012. We aimed to identify four age-matched and neighbourhood-matched controls for each case. We used conditional logistic regression and calculated PCV10 effectiveness as (1-adjusted matched odds ratio) × 100% for vaccine-type and vaccine-related serotypes (ie, in the same serogroup as a vaccine serotype).
  
  
  RESULTS
  In 316 cases (median age 13·2 months, range 2·6-53·1) and 1219 controls (13·3 months, 2·6-53·1), the adjusted effectiveness of an age-appropriate PCV10 schedule was 83·8% (95% CI 65·9-92·3) against vaccine serotypes, and 77·9% (41·0-91·7) against vaccine-related serotypes. Serotype-specific effectiveness was shown for the two most common vaccine serotypes-14 (87·7%, 60·8-96·1) and 6B (82·8%, 23·8-96·1)-and serotype 19A (82·2%, 10·7-96·4), a serotype related to vaccine serotype 19F. A single catch-up dose in children aged 12-23 months was effective against vaccine-type disease (68·0%, 17·6-87·6). No significant effectiveness was shown against non-vaccine serotypes for age-appropriate or catch-up schedules.
  
  
  CONCLUSIONS
  In the routine immunisation programme in Brazil, PCV10 prevents invasive disease caused by vaccine serotypes. PCV10 might provide cross-protection against some vaccine-related serotypes.
  
  
  BACKGROUND
  Brazilian Ministry of Health, Pan-American Health Organization, and US Centers for Disease Control and Prevention.
authors.affiliation: National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Brazil; Center for Tropical Medicine, University of Brasília, Brasília, Brazil. Electronic address: carla.domingues@saude.gov.br.
authors.forename: Carla Magda Allan S
authors.initials: CM
authors.lastname: Domingues
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Verani
authors.affiliation: National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Brazil.
authors.forename: Ernesto Issac
authors.initials: EI
authors.lastname: Montenegro Renoiner
authors.affiliation: National Reference Laboratory for Meningitis and Pneumococcal Infections, Bacteriology Center, Adolfo Lutz Institute, Secretary of Health of the State of São Paulo, São Paulo, Brazil.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: de Cunto Brandileone
authors.affiliation: Pan American Health Organization, Brasília, Brazil.
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.affiliation: Pan American Health Organization, Washington, DC, USA.
authors.forename: Lucia Helena
authors.initials: LH
authors.lastname: de Oliveira
authors.affiliation: Center for Tropical Medicine, University of Brasília, Brasília, Brazil.
authors.forename: João Barberino
authors.initials: JB
authors.lastname: Santos
authors.affiliation: Department of Social Medicine, School of Medical Sciences of Santa Casa, São Paulo, Brazil.
authors.forename: José Cássio
authors.initials: JC
authors.lastname: de Moraes
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D015995:Prevalence; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology*; D018074:Vaccines, Conjugate
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
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