title: Long-term Impact of a "3 + 0" Schedule for 7- and 13-Valent Pneumococcal Conjugate Vaccines on Invasive Pneumococcal Disease in Australia, 2002-2014.
abstract: BACKGROUND
  Australia introduced universal 7-valent pneumococcal conjugate vaccine (PCV7) from 2005, replaced by 13-valent PCV (PCV13) in 2011, uniquely among high-income countries giving doses at 2, 4, and 6 months (3 + 0 schedule). Data on impact of a timely 3 + 0 PCV schedule with high coverage are sparse, with none for PCV13.
  
  
  METHODS
  We used national surveillance of invasive pneumococcal disease (IPD) from 2002 for baseline and appropriate later comparison periods to calculate incidence rate ratios (IRRs) by serotype and age using a Poisson model. PCV coverage was assessed from the Australian Childhood Immunisation Register.
  
  
  RESULTS
  After 9 years of timely 3-dose PCV coverage of >92%, all-age IPD in Australia almost halved (IRR, 0.53; 95% confidence interval [CI], .50-.57), but differed by PCV era. Reductions in IPD due to vaccine serotypes from PCV7 (IRR, 0.20; CI, .17-.22) were about 2-fold greater than for IPD due to extra serotypes in PCV13 (13v-non7v) in a similar period (IRR, 0.58; CI, .51-.66). Post-PCV13 declines in serotype 19A IPD in persons aged <2 years (IRR, 0.23; CI, .13-.35) and ≥2 years (IRR, 0.35; CI, .28-.44) differed from other 13v-non7v IPD (IRR, 0.73; CI, .35-1.48 for those aged <2 years and IRR, 0.96; CI, .81-1.15 for those ≥2 years). Meningitis due to vaccine serotypes nearly disappeared in children eligible for 3 PCV13 doses. IPD due to non-PCV13 serotypes increased by 30% compared with 76% for non-PCV7 serotypes in equivalent period of vaccine use.
  
  
  CONCLUSIONS
  Reductions in vaccine-type IPD post-PCV13 were inferior to Australian experience with PCV7 and reports from high-income countries giving a PCV booster dose. Applicability of findings to other settings would depend on age of IPD onset, serotype profile, and timeliness of vaccination.
authors.affiliation: National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead; sanjay.jayasinghe@health.nsw.gov.au.|Discipline of Child and Adolescent Health, University of Sydney, and.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Jayasinghe
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney.
authors.forename: Rob
authors.initials: R
authors.lastname: Menzies
authors.affiliation: National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead.|Discipline of Child and Adolescent Health, University of Sydney, and.
authors.forename: Clayton
authors.initials: C
authors.lastname: Chiu
authors.affiliation: Office of Health Protection, Australian Government Department of Health, Canberra.
authors.forename: Cindy
authors.initials: C
authors.lastname: Toms
authors.affiliation: Department of Infectious Diseases and Microbiology, Princess Margaret Hospital, School of Paediatrics and Child Health and Telethon Kids Institute, University of Western Australia, Perth.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Blyth
authors.affiliation: Centre for Disease Control, Department of Health, Darwin, Northern Territory; and.
authors.forename: Vicki
authors.initials: V
authors.lastname: Krause
authors.affiliation: National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead.|Discipline of Child and Adolescent Health, University of Sydney, and.|School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McIntyre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000008:administration & dosage / Q000276:immunology*; D049674:History, 21st Century; D006801:Humans; D007115:Immunization Schedule; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000266:history / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011159:Population Surveillance; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology*; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000276:immunology*; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Australia; PCV13; PCV7; invasive pneumococcal disease; vaccine impact.