Journal
VACCINE
Volume 31, Issue 49, Pages 5863-5871Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.vaccine.2013.09.049
Keywords
Invasive pneumococcal disease; Case fatality; Vaccination programs
Categories
Funding
- Canadian Institutes for Health Research
- Ontario Thoracic Society
- US Centres for Disease Control and Prevention
- Abbott Laboratories of Canada
- Bayer Healthcare AG
- GlaxoSmithKline Inc.
- Pfizer, Inc.
- Abbott Laboratories
- Bayer Healthcare
- GlaxoSmithKline
- Hoffman LaRoche
- Pfizer
- Bristol-Myers Squibb, Canada
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Background: In 1995, a publicly funded pneumococcal vaccination program for 23-valent polysaccharide vaccine (PPV23) was introduced in Ontario. Conjugate vaccines were authorized in 2001 (PCV7), 2009 (PCV10) and 2010 (PCV13). Methods: From 1995-2011, active, population-based surveillance for invasive pneumococcal disease (IPD) was conducted in Metropolitan Toronto and Peel Region, Canada. Results: 6404 IPD cases were included. After PPV23 program implementation in 1995, IPD due to PPV23 strains decreased 49% in older adults prior to PCV7 introduction. Estimated PPV23 efficacy in vaccine eligible adults was 42.2% (95% CI; 28.6-53.2%). IPD incidence due to PCV7 serotypes in children <5 years decreased significantly after PCV7 authorization and before introduction of a publicly funded PCV7 program. Seven years after PCV7 program implementation, the incidence of IPD due to PCV7 serotypes decreased to zero in children and by 88% in adults, however, overall IPD incidence remained unchanged in adults. In 2011, the incidence of IPD was 4.5 per 100,000 in adults aged 15-64 and 19.9 per 100,000 in adults aged over 65 years, with 45 serotypes causing disease. Between 1995 and 2011, the case fatality rate of IPD in adults decreased 2% per year (95% CI, -0.9% to -3.2%). In multivariable analysis, predictors of mortality included older age, chronic conditions, nursing home residence, current smoking, bacteraemia, and illness due to serotypes 3,11A, 19A, and 19F. Conclusions: While vaccination programs resulted in substantial public health benefits, herd immunity benefits of PCV7 were seen at low pediatric vaccination rates, and the case fatality rate of IPD has decreased, IPD will continue to be a cause of considerable morbidity and mortality in adults. (C) 2013 Published by Elsevier Ltd.
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