Estimating the contribution of different age strata to vaccine serotype pneumococcal transmission in the pre vaccine era: a modelling study.
Adolescent
Adult
Age Factors
Child
Child, Preschool
Female
Humans
Immunity, Herd
/ immunology
Infant
Infant, Newborn
Male
Middle Aged
Models, Theoretical
Pneumococcal Infections
/ prevention & control
Pneumococcal Vaccines
/ administration & dosage
Vaccines, Conjugate
/ administration & dosage
Young Adult
Modelling
S. pneumoniae
Schedules
Transmission
Vaccination
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
10 06 2020
10 06 2020
Historique:
received:
10
12
2019
accepted:
21
04
2020
entrez:
11
6
2020
pubmed:
11
6
2020
medline:
15
12
2020
Statut:
epublish
Résumé
Herd protection through interruption of transmission has contributed greatly to the impact of pneumococcal conjugate vaccines (PCVs) and may enable the use of cost-saving reduced dose schedules. To aid PCV age targeting to achieve herd protection, we estimated which population age groups contribute most to vaccine serotype (VT) pneumococcal transmission. We used transmission dynamic models to mirror pre-PCV epidemiology in England and Wales, Finland, Kilifi in Kenya and Nha Trang in Vietnam where data on carriage prevalence in infants, pre-school and school-aged children and adults as well as social contact patterns was available. We used Markov Chain Monte Carlo methods to fit the models and then extracted the per capita and population-based contribution of different age groups to VT transmission. We estimated that in all settings, < 1-year-old infants cause very frequent secondary vaccine type pneumococcal infections per capita. However, 1-5-year-old children have the much higher contribution to the force of infection at 51% (28, 73), 40% (27, 59), 37% (28, 48) and 67% (41, 86) of the total infection pressure in E&W, Finland, Kilifi and Nha Trang, respectively. Unlike the other settings, school-aged children in Kilifi were the dominant source for VT infections with 42% (29, 54) of all infections caused. Similarly, we estimated that the main source of VT infections in infants are pre-school children and that in Kilifi 39% (28, 51) of VT infant infections stem from school-aged children whereas this was below 15% in the other settings. Vaccine protection of pre-school children is key for PCV herd immunity. However, in high transmission settings, school-aged children may substantially contribute to transmission and likely have waned much of their PCV protection under currently recommended schedules.
Sections du résumé
BACKGROUND
Herd protection through interruption of transmission has contributed greatly to the impact of pneumococcal conjugate vaccines (PCVs) and may enable the use of cost-saving reduced dose schedules. To aid PCV age targeting to achieve herd protection, we estimated which population age groups contribute most to vaccine serotype (VT) pneumococcal transmission.
METHODS
We used transmission dynamic models to mirror pre-PCV epidemiology in England and Wales, Finland, Kilifi in Kenya and Nha Trang in Vietnam where data on carriage prevalence in infants, pre-school and school-aged children and adults as well as social contact patterns was available. We used Markov Chain Monte Carlo methods to fit the models and then extracted the per capita and population-based contribution of different age groups to VT transmission.
RESULTS
We estimated that in all settings, < 1-year-old infants cause very frequent secondary vaccine type pneumococcal infections per capita. However, 1-5-year-old children have the much higher contribution to the force of infection at 51% (28, 73), 40% (27, 59), 37% (28, 48) and 67% (41, 86) of the total infection pressure in E&W, Finland, Kilifi and Nha Trang, respectively. Unlike the other settings, school-aged children in Kilifi were the dominant source for VT infections with 42% (29, 54) of all infections caused. Similarly, we estimated that the main source of VT infections in infants are pre-school children and that in Kilifi 39% (28, 51) of VT infant infections stem from school-aged children whereas this was below 15% in the other settings.
CONCLUSION
Vaccine protection of pre-school children is key for PCV herd immunity. However, in high transmission settings, school-aged children may substantially contribute to transmission and likely have waned much of their PCV protection under currently recommended schedules.
Identifiants
pubmed: 32517683
doi: 10.1186/s12916-020-01601-1
pii: 10.1186/s12916-020-01601-1
pmc: PMC7285529
doi:
Substances chimiques
Pneumococcal Vaccines
0
Vaccines, Conjugate
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
129Subventions
Organisme : Wellcome Trust
ID : 208812/Z/17/Z
Pays : United Kingdom
Organisme : Bill and Melinda Gates Foundation
ID : OPP1139859
Pays : International
Références
PLoS One. 2014 Aug 15;9(8):e104786
pubmed: 25127257
Clin Infect Dis. 2014 Dec 15;59(12):1724-32
pubmed: 25159581
PLoS One. 2013;8(2):e56079
pubmed: 23457504
Lancet Infect Dis. 2018 Apr;18(4):441-451
pubmed: 29395999
PLoS One. 2011;6(10):e26190
pubmed: 22022559
Pediatr Infect Dis J. 2001 Nov;20(11):1022-7
pubmed: 11734705
Lancet. 2009 Sep 12;374(9693):893-902
pubmed: 19748398
BMC Med. 2019 Dec 5;17(1):219
pubmed: 31801542
Epidemiol Infect. 2005 Oct;133(5):891-8
pubmed: 16181510
Proc Natl Acad Sci U S A. 1997 Jun 10;94(12):6571-6
pubmed: 9177259
Epidemiology. 2012 Jul;23(4):510-9
pubmed: 22441543
Lancet Infect Dis. 2017 Sep;17(9):965-973
pubmed: 28601421
Pediatr Infect Dis J. 2010 Jan;29(1):75-7
pubmed: 19907358
Epidemiol Infect. 2010 Jun;138(6):861-72
pubmed: 20018129
Lancet Glob Health. 2019 Jan;7(1):e58-e67
pubmed: 30554762
Biostatistics. 2013 Jul;14(3):541-55
pubmed: 23292757
Int J Epidemiol. 2012 Jun;41(3):650-7
pubmed: 22544844
Am J Epidemiol. 2019 Jan 1;188(1):160-168
pubmed: 30462150
Epidemics. 2018 Dec;25:72-79
pubmed: 30054196
Lancet Glob Health. 2014 Jul;2(7):e397-405
pubmed: 25103393
PLoS Med. 2011 Oct;8(10):e1001107
pubmed: 22028630
Epidemiol Infect. 2017 Oct;145(13):2750-2758
pubmed: 28847317
Hum Vaccin Immunother. 2018;14(8):1939-1947
pubmed: 29781740
PLoS Med. 2013;10(9):e1001517
pubmed: 24086113
Lancet Glob Health. 2018 Jul;6(7):e744-e757
pubmed: 29903376
BMC Infect Dis. 2009 Jun 27;9:102
pubmed: 19558701
Wkly Epidemiol Rec. ;92(48):729-47
pubmed: 29192459
Am J Epidemiol. 2013 Dec 1;178(11):1629-37
pubmed: 24091888
Wellcome Open Res. 2019 May 1;4:75
pubmed: 31168485
Lancet Infect Dis. 2019 Jun;19(6):e213-e220
pubmed: 30709666
PLoS Med. 2015 Jun 09;12(6):e1001839
pubmed: 26057994
Am J Epidemiol. 2016 Jan 1;183(1):70-8
pubmed: 26628514
Vaccine. 2017 Oct 27;35(45):6043-6046
pubmed: 28982625
Lancet Infect Dis. 2018 Feb;18(2):171-179
pubmed: 29174323
PLoS One. 2014 Jan 20;9(1):e85001
pubmed: 24465464
Vaccine. 2020 Jan 10;38(2):202-211
pubmed: 31668367
BMC Infect Dis. 2015 Jun 20;15:234
pubmed: 26088623
Wkly Epidemiol Rec. 2012 Apr 6;87(14):129-44
pubmed: 24340399
Am J Epidemiol. 2006 Nov 15;164(10):936-44
pubmed: 16968863
Epidemiol Infect. 2004 Jun;132(3):433-41
pubmed: 15188713
Clin Infect Dis. 2005 May 1;40(9):1215-22
pubmed: 15825020
Science. 2012 Mar 16;335(6074):1376-80
pubmed: 22383809
BMC Med. 2017 Jun 7;15(1):113
pubmed: 28592303
BMC Infect Dis. 2010 Apr 08;10:90
pubmed: 20377886
PLoS Med. 2013 Oct;10(10):e1001527
pubmed: 24115913
Lancet. 2011 Dec 3;378(9807):1962-73
pubmed: 21492929
Epidemics. 2009 Mar;1(1):2-13
pubmed: 21352747
PLoS Med. 2008 Mar 25;5(3):e74
pubmed: 18366252