Long-term effect of pneumococcal conjugate vaccines on invasive pneumococcal disease incidence among people of all ages from national, active, laboratory-based surveillance in South Africa, 2005-19: a cohort observational study.
Humans
South Africa
/ epidemiology
Pneumococcal Infections
/ prevention & control
Adult
Incidence
Pneumococcal Vaccines
/ administration & dosage
Infant
Child, Preschool
Young Adult
Child
Adolescent
Middle Aged
Female
Male
Aged
Vaccines, Conjugate
Cohort Studies
Streptococcus pneumoniae
/ immunology
Infant, Newborn
Heptavalent Pneumococcal Conjugate Vaccine
/ administration & dosage
Journal
The Lancet. Global health
ISSN: 2214-109X
Titre abrégé: Lancet Glob Health
Pays: England
ID NLM: 101613665
Informations de publication
Date de publication:
Sep 2024
Sep 2024
Historique:
received:
01
03
2024
revised:
16
05
2024
accepted:
10
06
2024
medline:
17
8
2024
pubmed:
17
8
2024
entrez:
16
8
2024
Statut:
ppublish
Résumé
In South Africa, 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009 and 13-valent PCV (PCV13) was introduced in 2011, both in a two plus one schedule. We evaluated the ongoing effects of PCV on the prevention of invasive pneumococcal disease (IPD) over 15 years of sustained surveillance in South Africa before the COVID-19 pandemic. We conducted national, active, laboratory-based surveillance for IPD among all ages in South Africa, including isolate serotyping and susceptibility testing. We fitted linear regression models with vaccine covariates to imputed IPD case counts each year by serotype and age to compare expected and actual IPD cases in 2019, which was the main outcome. Vaccine effects were set to zero to identify expected incidence after the introduction of PCV7 and PCV13. From Jan 1, 2005, to Dec 31, 2019, surveillance identified 52 957 IPD cases. Among the 50 705 individuals with age data available, 9398 (18·5%) were infants aged younger than 2 years. Compared with expected case numbers (no vaccination) predicted using all available data, overall IPD rates among children younger than 2 years declined by 76·0% (percentage risk difference; 95% CI -79·0 to -72·8%) in 2019; notably, PCV7 and additional PCV13 serotype IPD rates declined by 95·5% (-97·0 to -93·4%) and 93·8% (-96·2 to-90·5%), respectively, whereas non-vaccine serotypes (NVTs) did not change significantly. Among adults aged 25-44 years, overall IPD declined by 50·4% (-54·2 to -46·3%), and PCV7 and additional PCV13 serotype IPD rates declined by 86·1% (-88·7 to -83·1%) and 77·2% (-80·9 to -73·0%), respectively, whereas NVTs increased by 78·5% (56·8 to 103·4%). Individuals aged older than 64 years also benefited from declines in IPD (-30·2%; -41·9 to -16·2%), but NVTs increased (234·9%; 138·1 to 379·4%). We documented sustained direct and indirect benefits of PCV across age groups, and NVT increases in adults older than 24 years. Higher valency PCVs would have the added benefit of preventing this residual disease. National Institute for Communicable Diseases of the National Health Laboratory Service (South Africa) and US Agency for International Development Antimicrobial Resistance Initiative, US Centers for Disease Control and Prevention.
Sections du résumé
BACKGROUND
BACKGROUND
In South Africa, 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009 and 13-valent PCV (PCV13) was introduced in 2011, both in a two plus one schedule. We evaluated the ongoing effects of PCV on the prevention of invasive pneumococcal disease (IPD) over 15 years of sustained surveillance in South Africa before the COVID-19 pandemic.
METHODS
METHODS
We conducted national, active, laboratory-based surveillance for IPD among all ages in South Africa, including isolate serotyping and susceptibility testing. We fitted linear regression models with vaccine covariates to imputed IPD case counts each year by serotype and age to compare expected and actual IPD cases in 2019, which was the main outcome. Vaccine effects were set to zero to identify expected incidence after the introduction of PCV7 and PCV13.
FINDINGS
RESULTS
From Jan 1, 2005, to Dec 31, 2019, surveillance identified 52 957 IPD cases. Among the 50 705 individuals with age data available, 9398 (18·5%) were infants aged younger than 2 years. Compared with expected case numbers (no vaccination) predicted using all available data, overall IPD rates among children younger than 2 years declined by 76·0% (percentage risk difference; 95% CI -79·0 to -72·8%) in 2019; notably, PCV7 and additional PCV13 serotype IPD rates declined by 95·5% (-97·0 to -93·4%) and 93·8% (-96·2 to-90·5%), respectively, whereas non-vaccine serotypes (NVTs) did not change significantly. Among adults aged 25-44 years, overall IPD declined by 50·4% (-54·2 to -46·3%), and PCV7 and additional PCV13 serotype IPD rates declined by 86·1% (-88·7 to -83·1%) and 77·2% (-80·9 to -73·0%), respectively, whereas NVTs increased by 78·5% (56·8 to 103·4%). Individuals aged older than 64 years also benefited from declines in IPD (-30·2%; -41·9 to -16·2%), but NVTs increased (234·9%; 138·1 to 379·4%).
INTERPRETATION
CONCLUSIONS
We documented sustained direct and indirect benefits of PCV across age groups, and NVT increases in adults older than 24 years. Higher valency PCVs would have the added benefit of preventing this residual disease.
FUNDING
BACKGROUND
National Institute for Communicable Diseases of the National Health Laboratory Service (South Africa) and US Agency for International Development Antimicrobial Resistance Initiative, US Centers for Disease Control and Prevention.
Identifiants
pubmed: 39151982
pii: S2214-109X(24)00263-8
doi: 10.1016/S2214-109X(24)00263-8
pii:
doi:
Substances chimiques
Pneumococcal Vaccines
0
Vaccines, Conjugate
0
13-valent pneumococcal vaccine
0
Heptavalent Pneumococcal Conjugate Vaccine
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1470-e1484Investigateurs
Khatija Ahmed
(K)
Colleen Bamford
(C)
John Black
(J)
Lucille Blumberg
(L)
Adrian Brink
(A)
Halima Dawood
(H)
Nomonde Dlamini
(N)
Andries Dreyer
(A)
Desiree du Plessis
(D)
Joy Ebonwu
(J)
Linda Erasmus
(L)
Charles Feldman
(C)
John Frean
(J)
Nelesh Govender
(N)
Chetna Govind
(C)
Sumayya Haffejee
(S)
Ken Hamese
(K)
Khine Swe Swe Han
(KSS)
Nombulelo Hoho
(N)
Ebrahim Hoosien
(E)
Victoria Howell
(V)
Greta Hoyland
(G)
Gillian Hunt
(G)
Farzana Ismail
(F)
Husna Ismail
(H)
Nazir Ismail
(N)
Prudence Ive
(P)
Pieter Jooste
(P)
Ignatius Khantsi
(I)
Tiisetso Lebaka
(T)
Neo Legare
(N)
Ruth Lekalakala
(R)
Warren Lowman
(W)
Prasha Mahabeer
(P)
Adhil Maharj
(A)
Martha Makgoba
(M)
Motlatji Maloba
(M)
Caroline Maluleka
(C)
Nontuthuko Maningi
(N)
Louis Marcus
(L)
Terry Marshall
(T)
Rudzani Mathebula
(R)
Azwifarwi Mathunjwa
(A)
Nontombi Mbelle
(N)
Kerrigan McCarthy
(K)
Colin Menezes
(C)
Cecilia Miller
(C)
Koleka Mlisana
(K)
Masego Moncho
(M)
David Moore
(D)
Myra Moremi
(M)
Lynn Morris
(L)
Ruth Mpembe
(R)
Portia Mutevedzi
(P)
Judith Mwansa-Kambafwile
(J)
Fathima Naby
(F)
Romola Naidoo
(R)
Trusha Nana
(T)
Maphoshane Nchabeleng
(M)
Mimmy Ngomane
(M)
Wendy Ngubane
(W)
Sunnieboy Njikho
(S)
Sindi Ntuli
(S)
Nicola Page
(N)
Vanessa Pearce
(V)
Olga Perovic
(O)
Keshree Pillay
(K)
Xoliswa Poswa
(X)
Elizabeth Prentice
(E)
Frans Radebe
(F)
Praksha Ramajathan
(P)
Ntisieni Ramalwa
(N)
Kessendri Reddy
(K)
Gary Reubenson
(G)
Jenny Rossouw
(J)
Catherine Samuel
(C)
Sharona Seetharam
(S)
Mirriam Selekisho
(M)
Marthinus Senekal
(M)
Liliwe Shuping
(L)
Ngoaka Sibiya
(N)
Surendra Sirkar
(S)
Juanita Smit
(J)
Anthony Smith
(A)
Marshagne Smith
(M)
Lisha Sookan
(L)
Charlotte Sriruttan
(C)
Juno Thomas
(J)
Merika Tsitsi
(M)
Erika van Schalkwyk
(E)
Ebrahim Variava
(E)
Charl Verwey
(C)
Jeannette Wadula
(J)
Sibongile Walaza
(S)
Jacqueline Weyer
(J)
Andrew Whitelaw
(A)
Inge Zietsman
(I)
Informations de copyright
Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of interests SAM has received grant funds from MSD, Pfizer, GSK, and the Bill and Melinda Gates Foundation; and honoraria from GSK, related to this work. CvM declares grant funds from Pfizer. CvM and VC declare honoraria from MSD and Pfizer. CC declares grant funds from Sanofi and the Bill and Melinda Gates Foundation. All other authors declare no competing interests.