Journal
JOURNAL OF INFECTION
Volume 65, Issue 1, Pages 17-24Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.jinf.2012.02.017
Keywords
Invasive pneumococcal disease; Hospitalisation; Mortality; Linkage; Risk groups; Vaccination; Risk
Categories
Funding
- UK Department of Health [039/0031]
- Wyeth (Pfizer)
- GlaxoSmithKline
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Objective: To inform national policy making on the use of the 13-valent pneumococcal vaccine among risk groups we estimated the increased risk of invasive pneumococcal disease (IPD) outcomes among clinical risk groups. Three years of post 7-valent pneumococcal conjugate vaccine (PCV7) data was included to investigate the herd protection effects. Methods: Over 22,000 IPD patients in England (March 2002-March 2009 - aged 2 and over) were linked to their hospitalisation records. The prevalence of risk factors in these patients was compared to the prevalence of risk factors in the general population. Results: There was an increased odds ratio (OR) for hospitalisation (OR 11.7 2-15 years; 7.6 16-64; 2.7 65+) and death (OR 2.4 2-15 years, 3.9 16-64, 1.2 65+) from IPD among risk group. The most important risk factors that predict IPD are chronic liver disease, immunosuppression, and chronic respiratory diseases. Herd protection effects due to introduction of the 7-valent vaccine were identical in both patient groups as shown by the similar decline in the proportion of IPD caused by PCV7 serotypes in risk and non-risk groups. Conclusions: There is a marked increased risk of IPD among those with certain clinical conditions, suggesting potential benefit from a targeted vaccination approach. However, the indirect protection from conjugate vaccination of children suggests PCV vaccination of high-risk groups may not provide substantial additional benefit once herd immunity takes effect. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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