Program Schedule

597
Increase in IPD incidence in Adults in 2013-2014 after 2 consecutive years of decline following introduction of 13-valent pneumococcal conjugate vaccine (PCV13)

Session: Oral Abstract Session: Adult Vaccines
Friday, October 10, 2014: 9:00 AM
Room: The Pennsylvania Convention Center: 111-AB
Background:

The impact of the 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal disease in children and adults has been substantial. In 2010, PCV13, a second generation pneumococcal conjugate vaccine was introduced for infants with catch up dosing.  A decline in IPD and specifically vaccine serotypes in children < 5 years of age has already been reported.  We present data on the incidence and serotype distribution of IPD in adults over 18 years of age for the 6 years before and after introduction of PCV13.

Methods:

Kaiser Permanente Northern California (KPNC) is an integrated health care plan serving approximately 3.3 million members.   IPD cases were identified from the KPNC Lab system, and defined as S.pneumoniae from a normally sterile body site, from May 2008 through April 2014, in members age 18 and over.  Serotyping was done at the Boston University Schools of Medicine. Age and race were derived from KPNC membership databases.  Rates were calculated as Annual Incidence of IPD = (IPD cases / (Membership / 105).  Study years begin in May and end in April of the following year, to coincide with the introduction of PCV13.

Results:

The rate of IPD in the adult population declined coinciding with the introduction of PCV13 (5.10-4.11 per 100,000) and continued through the year ending April 2013 (table 1).  In 2014 an increase in incidence, mainly in non-PCV13 serotypes, was observed.  The greatest increase from 2013 to 2014 was in individuals of Black race (10.38 per 100,000 in 2012 to 20.64 per 100,000 in 2013).  In this group, the increase was observed in PCV7, PCV13, and non-PCV13 serotypes.

Conclusion:

We observed increased IPD in adults in 2013-2014 after 2 consecutive years of decline following PCV13 introduction.  Much of this increase was seen in individuals of Black race.  Racial differences should be considered in policy decisions regarding use of the conjugated vaccine in adults.

 Table.  Rates of IPD in KPNC, 2008-2014, per 100,000.  Serotype categories contain serotypes specific to the vaccines.

Serotype Category

5/08-4/09

5/09-4/10

Year of PCV13 Introduction 5/10-4/11

5/11-4/12

5/12-4/13

5/13-4/14

All Cases

9.91

11.72

10.83

10.26

7.97

8.61

PCV13

4.90

5.78

5.42

4.51

2.96

2.59

PCV7

0.37

0.27

0.30

0.33

0.29

0.28

Non- PCV13

3.81

4.37

4.41

5.13

4.26

4.73

Roger Baxter, MD1, Charlie Chao1, Arnold Yee, MBA1, Laurie Aukes, RN1 and Stephen I. Pelton, MD2, (1)Kaiser Permanente Vaccine Study Center, Oakland, CA, (2)Pediatric Infectious Diseases, Boston Medical Center, Boston, MA

Disclosures:

R. Baxter, GSK: Investigator, Research grant
Merck: Investigator, Research grant
Pfizer: Investigator, Research grant
Novartis: Investigator, Research grant
MedImmune: Investigator, Research grant
Sanofi Pasteur: Investigator, Research grant

C. Chao, None

A. Yee, None

L. Aukes, None

S. I. Pelton, Pfizer, Inc: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient
GSK bio: Scientific Advisor, Consulting fee

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