679. Indirect Effects of 13-valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Pneumonia in Adults
Session: Oral Abstract Session: Pneumococcal Vaccine for All Ages
Friday, October 4, 2013: 11:15 AM
Room: The Moscone Center: 200-212
Background: A significant indirect effect was shown in adults after seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in children aged 2–59 months. In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the immunization schedule. We examined rates of invasive pneumococcal pneumonia (IPP) before and after PCV13 introduction to evaluate the indirect impact of PCV13 on adults.

Methods: IPP cases (adults ≥ 18 years with bacteremic pneumonia and pneumococcus isolated from a normally sterile site) were identified from the Emerging Infections Program Network’s Active Bacterial Core surveillance (ABCs), an active, laboratory and population-based surveillance system of 29 million persons. Isolates were serotyped at reference laboratories. We focused on the 6 serotypes (PCV6) included in PCV13 that are not in PCV7. Cases with missing serotype results were distributed according to those with known serotypes. We compared annual rates (cases per 100,000) of PCV6-type IPP during July 2011–June 2012 (after PCV13 introduction) to July 2009–June 2010 (baseline).

Results: During July 2009–June 2010 and July 2011–June 2012, 2,447 and 1,863 IPP cases were identified, respectively; 91% of cases had serotyping results. Crude rates in adults were 11.1/100,000 during the baseline period and 8.3/100,000 after PCV13 introduction. For both periods, rates increased with age.  After PCV13 introduction, PCV6-type IPP declined significantly from baseline rates among all adult age groups, with the largest decline occurring among those aged 18–49 years (Table). Serotypes 7F and 19A caused 78% of PCV6-type IPP during the baseline period, but experienced reductions of 60% and 45% after PCV13 introduction, respectively; serotype 6C IPP declined by 31%.

Table. PCV6-type IPP rates (cases per 100,000 persons in ABCs) before and after PCV13 introduction, by age

Age (years)

Baseline

(July 2009–June 2010)

After PCV13 introduction

(July 2011–June 2012)

Percent change (%)

18–49

2.8

1.3

-53*

50–64

7.2

3.9

-46*

65–79

9.5

5.3

-45*

≥ 80

15.5

9.9

 -36*

* Significant result (p-value < 0.002) due to multiple comparisons

Conclusion: Significant declines in IPP among adults occurred within 2 years of PCV13 introduction, demonstrating a rapid indirect effect.

Lindsay Kim, MD, MPH1, Ryan Gierke, MPH1, Melissa Lewis, MPH2, Ruth Link-Gelles, MPH1, Monica M. Farley, MD3, William Schaffner, MD4, Ann Thomas, MD, MPH5, Arthur Reingold, MD6, Lee Harrison, MD7, Ruth Lynfield, MD8, Nancy Bennett, MD, MS9, Susan Petit, MPH10, Lisa Miller, MD, MSPH11, Joseph Bareta, MS12, Lesley Mcgee, PhD1, Cynthia Whitney, MD, MPH1 and Matthew Moore, MD, MPH1, (1)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Biostatistics Office, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (3)Emory University and Atlanta Veterans Administration Medical Center, Atlanta, GA, (4)Vanderbilt University School of Medicine, Nashville, TN, (5)Oregon Health Authority, Portland, OR, (6)University of California, Berkeley, CA, (7)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (8)Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, MN, (9)University of Rochester School of Medicine and Dentistry, Rochester, NY, (10)Connecticut Department of Public Health, Hartford, CT, (11)Colorado Department of Public Health and Environment, Denver, CO, (12)New Mexico Department of Health, Santa Fe, NM

Disclosures:

L. Kim, None

R. Gierke, None

M. Lewis, None

R. Link-Gelles, None

M. M. Farley, None

W. Schaffner, Pfizer: Consultant, Consulting fee
GlaxoSmithKline: Consultant, Consulting fee
Sanofi-Pasteur: Consultant, Consulting fee

A. Thomas, None

A. Reingold, None

L. Harrison, Pfizer: Consultant, Consulting fee
Merck: Consultant, Consulting fee

R. Lynfield, None

N. Bennett, None

S. Petit, None

L. Miller, None

J. Bareta, None

L. Mcgee, None

C. Whitney, None

M. Moore, None

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