title: Effect of high-valency pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries: an observational multicentre study.
abstract: The Streptococcus pneumoniae Invasive Disease network (SpIDnet) actively monitors populations in nine sites in seven European countries for invasive pneumococcal disease. Five sites use 13-valent pneumococcal conjugate vaccine (PCV13) alone and four use the ten-valent PCV (PCV10) and PCV13. Vaccination uptake is greater than 90% in six sites and 67-78% in three sites. We measured the effects of introducing high-valency PCVs on the incidence of invasive pneumococcal disease in children younger than 5 years.
  
  
  
  We compared the incidence of invasive pneumococcal disease in each of the 4 years after the introduction of PCV13 alone or PCV10 and PCV13 with the average incidence during the preceding period of heptavalent PCV (PCV7) use, overall and by serotype category. We calculated incidence rate ratios (IRRs) and 95% CIs for each year and pooled the values for all sites in a random effects meta-analysis.
  
  
  
  4 years after the introduction of PCV13 alone or PCV10 and PCV13, the pooled IRR was 0·53 (95% CI 0·43-0·65) for invasive pneumococcal disease in children younger than 5 years caused by any serotype, 0·16 (0·07-0·40) for disease caused by PCV7 serotypes, 0·17 (0·07-0·42) for disease caused by 1, 5, and 7F serotypes, and 0·41 (0·25-0·69) for that caused by 3, 6A and 19A serotypes. We saw a similar pattern when we restricted the analysis to sites where only PCV13 was used. The pooled IRR for invasive pneumococcal disease caused by non-PCV13 serotypes was 1·62 (1·09-2·42).
  
  
  
  The incidence of invasive pneumococcal disease caused by all serotypes decreased due to a decline in the incidence of vaccine serotypes. By contrast, that of invasive pneumococcal disease caused by non-PCV13 serotypes increased, which suggests serotype replacement. Long-term surveillance will be crucial to monitor the further effects of PCV10 and PCV13 vaccination programmes in young children.
  
  
  
  European Centre for Disease Prevention and Control, Czech National Institute of Public Health, French National Agency for Public Health, Irish Health Services Executive, Norwegian Institute of Public Health, Public Health Agency of Catalonia, Public Health Department of Community of Madrid, Navarra Hospital Complex, Public Health Institute of Navarra, CIBER Epidemiology and Public Health, Institute of Health Carlos III, Public Health Agency of Sweden, and NHS Scotland.
authors.affiliation: Epidemiology Department, EpiConcept, Paris, France. Electronic address: c.savulescu@epiconcept.fr.
authors.forename: Camelia
authors.initials: C
authors.lastname: Savulescu
authors.affiliation: Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
authors.forename: Pavla
authors.initials: P
authors.lastname: Krizova
authors.affiliation: Infectious Disease Department, French National Agency for Public Health, Saint-Maurice, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Lepoutre
authors.affiliation: Vaccine Preventable Disease Department, Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: Jolita
authors.initials: J
authors.lastname: Mereckiene
authors.affiliation: Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Didrik F
authors.initials: DF
authors.lastname: Vestrheim
authors.affiliation: General Sub-Directorate for Surveillance and Public Health Emergency Response, Public Health Agency of Catalunya, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Ciruela
authors.affiliation: Sub-Directorate of Health Promotion and Prevention, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Ordobas
authors.affiliation: Public Health Institute of Navarra-IdiSNA, Pamplona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: Guevara
authors.affiliation: Health Protection Scotland, National Services Scotland, Glasgow, UK.
authors.forename: Eisin
authors.initials: E
authors.lastname: McDonald
authors.affiliation: Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Morfeldt
authors.affiliation: Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Kozakova
authors.affiliation: National Centre for Pneumococci, European Hospital George Pompidou, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Varon
authors.affiliation: Vaccine Preventable Disease Department, Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Cotter
authors.affiliation: Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Brita A
authors.initials: BA
authors.lastname: Winje
authors.affiliation: CIBER Epidemiología y Salud Pública, Madrid, Spain; Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain; International University of Catalunya, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Munoz-Almagro
authors.affiliation: Sub-Directorate of Health Promotion and Prevention, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia
authors.affiliation: Public Health Institute of Navarra-IdiSNA, Pamplona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Castilla
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden; Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Henriques-Normark
authors.affiliation: Office of Chief Scientist Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Lucia Pastore
authors.initials: LP
authors.lastname: Celentano
authors.affiliation: Epidemiology Department, EpiConcept, Paris, France.
authors.forename: Germaine
authors.initials: G
authors.lastname: Hanquet
mesh_terms: D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D015994:Incidence; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D013296:Streptococcus pneumoniae / Q000276:immunology
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines