title: Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance.
abstract: BACKGROUND
  In 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA.
  
  
  METHODS
  We used laboratory-based and population-based data on incidence of IPD from the Active Bacterial Core surveillance (part of the Centers for Disease Control and Prevention's Emerging Infections Program) in a time-series model to compare rates of IPD before and after the introduction of PCV13. Cases of IPD between July 1, 2004, and June 30, 2013, were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13 minus PCV7). In a time-series model, we used an expected outcomes approach to compare the reported incidence of IPD to that which would have been expected if PCV13 had not replaced PCV7.
  
  
  RESULTS
  Compared with incidence expected among children younger than 5 years if PCV7 alone had been continued, incidence of IPD overall declined by 64% (95% interval estimate [95% IE] 59-68) and IPD caused by PCV13 minus PCV7 serotypes declined by 93% (91-94), by July, 2012, to June, 2013. Among adults, incidence of IPD overall also declined by 12-32% and IPD caused by PCV13 minus PCV7 type IPD declined by 58-72%, depending on age. We estimated that over 30 000 cases of IPD and 3000 deaths were averted in the first 3 years after the introduction of PCV13.
  
  
  CONCLUSIONS
  PCV13 reduced IPD across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations.
  
  
  BACKGROUND
  Centers for Disease Control and Prevention.
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: matt.moore@cdc.hhs.gov.
authors: Matthew R
authors: MR
authors: Moore
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Ruth
authors: R
authors: Link-Gelles
authors: Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors: William
authors: W
authors: Schaffner
authors: Minnesota Department of Health, St Paul, MN, USA.
authors: Ruth
authors: R
authors: Lynfield
authors: Minnesota Department of Health, St Paul, MN, USA.
authors: Catherine
authors: C
authors: Lexau
authors: Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors: Nancy M
authors: NM
authors: Bennett
authors: Connecticut Department of Public Health, Hartford, CT, USA.
authors: Susan
authors: S
authors: Petit
authors: New York State Department of Health, Albany, NY, USA.
authors: Shelley M
authors: SM
authors: Zansky
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Lee H
authors: LH
authors: Harrison
authors: California Emerging Infections Program, Oakland, CA, USA; School of Public Health, Department of Epidemiology, University of California, Berkeley, CA, USA.
authors: Arthur
authors: A
authors: Reingold
authors: Colorado Department of Public Health and Environment, Denver, CO, USA.
authors: Lisa
authors: L
authors: Miller
authors: Institute for Public Health, University of New Mexico, Emerging Infections Program, Albuquerque, NM, USA.
authors: Karen
authors: K
authors: Scherzinger
authors: Oregon Public Health Division and Oregon Emerging Infections Program, Portland, OR, USA.
authors: Ann
authors: A
authors: Thomas
authors: Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Infection Disease Section, Medical Specialty Care Service Line, Atlanta VA Medical Center, Atlanta, GA, USA.
authors: Monica M
authors: MM
authors: Farley
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Stat-Epi Associates, Ponte Vedra Beach, FL, USA.
authors: Elizabeth R
authors: ER
authors: Zell
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Thomas H
authors: TH
authors: Taylor
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Tracy
authors: T
authors: Pondo
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Loren
authors: L
authors: Rodgers
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Lesley
authors: L
authors: McGee
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Bernard
authors: B
authors: Beall
authors: Department of Pathology, University of Texas Health Science Center, San Antonio, TX, USA.
authors: James H
authors: JH
authors: Jorgensen
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Cynthia G
authors: CG
authors: Whitney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000517:prevention & control*; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines
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