title: Evaluating the impact of PCV-10 on invasive pneumococcal disease in Brazil: A time-series analysis.
abstract: Routine infant immunization with 10-valent pneumococcal conjugate vaccine (PCV-10) began in Brazil in 2010. The impact of the PCV-10 on rates of invasive pneumococcal disease (IPD) at the population level was not yet evaluated. Serotype-specific IPD changes after PCV-10 introduction is still to be determined. Data from national surveillance system for notifiable diseases (SINAN) and national reference laboratory for S. pneumoniae in Brazil (IAL) were linked to enhance case ascertainment of IPD. An interrupted time-series analysis was conducted to predict trends in the postvaccination IPD rates in the absence of PCV-10 vaccination, taking into consideration seasonality and secular trends. PCVs serotype-specific distribution were assessed before (2008-2009) and after (2011-2013) the introduction of PCV-10 in the immunization program. A total of 9,827 IPD cases were identified from 2008-2013 when combining SINAN and IAL databases. Overall, PCV-10 types decreased by 41.3% after PCV-10 vaccination period, mostly in children aged 2-23 months, while additional PCV-13 serotypes increased by 62.8% mainly in children under 5-year of age. For children aged 2-23 months, targeted by the immunization program, we observed a 44.2% (95%CI, 15.8-72.5%) reduction in IPD rates. In contrast, significant increase in IPD rates were observed for adults aged 18-39 y (18.9%, 95%CI 1.1-36.7%), 40-64 y (52.5%, 95%CI 24.8-80.3%), and elderly ≥ 65 y (79.3%, 95%CI 62.1-96.5%). This is the first report of a time-series analysis for PCV impact in IPD conducted at national level data in a developing country. We were able to show significant impact of PCV-10 on IPD for age groups targeted by vaccination in Brazil, 3 y after its introduction. No impact on other age groups was demonstrated.
authors.affiliation: a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil.
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Andrade
authors.affiliation: b School of Nursing ; Federal University of Goias ; Goiânia , Brazil.
authors.forename: Ruth
authors.initials: R
authors.lastname: Minamisava
authors.affiliation: a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Policena
authors.affiliation: c Advisor of the Ministry of Health ; San Paulo , Brazil.
authors.forename: Elier B
authors.initials: EB
authors.lastname: Cristo
authors.affiliation: d Secretariat of Health Surveillance ; Brazilian Ministry of Health ; Brasilia , Federal District , Brazil.
authors.forename: Carla Magda S
authors.initials: CM
authors.lastname: Domingues
authors.affiliation: e Laboratory for Meningitis , Pneumonia and Pneumococcal Infection; Center of Bacteriology; Adolfo Lutz Institute; Secretary of Health of State of Sao Paulo ; Sao Paulo , Brazil.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: de Cunto Brandileone
authors.affiliation: e Laboratory for Meningitis , Pneumonia and Pneumococcal Infection; Center of Bacteriology; Adolfo Lutz Institute; Secretary of Health of State of Sao Paulo ; Sao Paulo , Brazil.
authors.forename: Samanta Cristine Grassi
authors.initials: SC
authors.lastname: Almeida
authors.affiliation: a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil.
authors.forename: Cristiana Maria
authors.initials: CM
authors.lastname: Toscano
authors.affiliation: a Institute of Tropical Pathology and Public Health ; Federal University of Goias ; Goiânia , Brazil.
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Bierrenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D017589:Immunization Programs; D007153:Immunologic Deficiency Syndromes / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D007223:Infant; D053592:Interleukin-1 Receptor-Associated Kinases; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000276:immunology*; D000081207:Primary Immunodeficiency Diseases; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000276:immunology; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000276:immunology*; D055815:Young Adult
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D053592:Interleukin-1 Receptor-Associated Kinases
keywords: Streptococcus pneumoniae; data linkage; impact; interrupted time-series analysis; invasive pneumococcal disease; meningitis; pneumococcal vaccines; surveillance