The 13-valent pneumococcal conjugate vaccine (PCV13) does not appear to provide much protection on combined invasive disease due to the six PCV13 non-PCV7 serotypes 1, 3, 5, 6A, 7F, and 19A in Kuwait during 2010-2019.

Kuwait started immunizing children <2 y age with the 7-valent pneumococcal conjugate vaccine, PCV7 from August 2007. PCV7 was replaced by the 13-valent conjugate vaccine, PCV13 from August 2010. In a previous analysis of the results for the period, August 2010-July 2013 (period II), there was no evidence of serotype-specific protection for invasive disease against the additional six serotypes to PCV7 present in PCV13 (non-PCV7 serotypes) as evidenced by isolation from blood and cerebrospinal fluid in any of the age groups, <2 y, 2-5 y, 6-50 y, 51-65 y, and >65 y and all ages, compared to the pre-vaccination period, August 2003-July 2006 (period I). In the current study, we allowed additional time, August 2013-July 2019 (period III) for better vaccine effect and repeated the analysis. We did not find any significant decrease of invasive disease due to the non-PCV7 serotypes of PCV13 in period III and combined II and III periods compared to period I. However, these comparisons showed significant reductions for four of the six and total serotypes of PCV7, and total serotypes of PCV13. Reduction for total PCV13 serotypes was contributed by serotypes of PCV7. It appears that the six non-PCV7 serotypes in PCV13 do not offer much protection. Some contributory factors for the poor effect of the non-PCV7 serotypes may be related to few cases with underpowered statistical analysis, lack of vaccine coverage data, method of vaccine efficacy analysis based on vaccine serotypes relative to all serotypes and unusual rise in non-typeable isolates post vaccination that would have masked true serotypes.