Shalom Ben-Shimol1, David Greenberg1, Noga Givon-Lavi1, Yechiel Schlesinger2, Eli Somekh3, Shraga Aviner4, Dan Miron5, Ron Dagan6. 1. The Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel. 2. Shaare Zedek Medical Center, Jerusalem, Israel. 3. Wolfson Medical Center, Holon, Israel. 4. The Barzilai Medical Center, Ashkelon, Israel. 5. The Pediatric Infectious Disease Service, HaEmek Medical Center, Afula, Israel. 6. The Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel. Electronic address: rdagan@bgu.ac.il.
Abstract
BACKGROUND: The 7-valent pneumococcal conjugated vaccine (PCV7) was introduced to the Israeli national immunization plan (NIP) in July 2009 (administered at age 2, 4 and 12 months), with a fast reduction of invasive pneumococcal disease (IPD) caused by PCV7 serotypes. Starting in November 2010, PCV13 gradually replaced PCV7. AIM: To report the impact of PCV7/PCV13 sequential introduction on IPD in Israeli children <5 years. METHODS: An ongoing nationwide, prospective, population-based, active surveillance. All IPD episodes (Streptococcus pneumoniae isolated from blood and/or cerebrospinal fluid) from July 2004 through June 2013 were included. RESULTS: Overall, 2670 IPD episodes were recorded. Incidence of IPD caused by PCV7+6A serotypes during the PCV13 period vs. pre-PCV period decreased by 95% (Incidence Rate Ratio [IRR]=0.05; 95% CI=0.03-0.09). This reduction was observed in a two-step manner: 90% in the PCV7-period and further 5% in the PCV13-period. The rates of IPD caused by the 5 additional PCV13-serotypes (1, 3, 5, 7F, 19A; 5VT) increased initially by 47%, but subsequently decreased by 79%, resulting in an overall 70% reduction during the entire study period (IRR=0.30; 0.21-0.44). A two-fold increase in non-PCV13 serotypes IPD was observed (IRR=2.43; 1.73-3.66). In total, a 63% reduction of all-serotype IPD episodes was observed in children <5 years (69% and 48% in children <2 and 2-4 years old, respectively). CONCLUSIONS: After initiation of PCV NIP, a rapid and substantial 2-step IPD reduction was observed in children <5 years. The serotype-specific rate reduction reflected the sequential introduction of PCV7/PCV13.
BACKGROUND: The 7-valentpneumococcal conjugated vaccine (PCV7) was introduced to the Israeli national immunization plan (NIP) in July 2009 (administered at age 2, 4 and 12 months), with a fast reduction of invasive pneumococcal disease (IPD) caused by PCV7 serotypes. Starting in November 2010, PCV13 gradually replaced PCV7. AIM: To report the impact of PCV7/PCV13 sequential introduction on IPD in Israeli children <5 years. METHODS: An ongoing nationwide, prospective, population-based, active surveillance. All IPD episodes (Streptococcus pneumoniae isolated from blood and/or cerebrospinal fluid) from July 2004 through June 2013 were included. RESULTS: Overall, 2670 IPD episodes were recorded. Incidence of IPD caused by PCV7+6A serotypes during the PCV13 period vs. pre-PCV period decreased by 95% (Incidence Rate Ratio [IRR]=0.05; 95% CI=0.03-0.09). This reduction was observed in a two-step manner: 90% in the PCV7-period and further 5% in the PCV13-period. The rates of IPD caused by the 5 additional PCV13-serotypes (1, 3, 5, 7F, 19A; 5VT) increased initially by 47%, but subsequently decreased by 79%, resulting in an overall 70% reduction during the entire study period (IRR=0.30; 0.21-0.44). A two-fold increase in non-PCV13 serotypes IPD was observed (IRR=2.43; 1.73-3.66). In total, a 63% reduction of all-serotype IPD episodes was observed in children <5 years (69% and 48% in children <2 and 2-4 years old, respectively). CONCLUSIONS: After initiation of PCV NIP, a rapid and substantial 2-step IPD reduction was observed in children <5 years. The serotype-specific rate reduction reflected the sequential introduction of PCV7/PCV13.
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