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Chapter 24 : Direct and Indirect Effectiveness and Safety of Pneumococcal Conjugate Vaccine in Practice
Category: Bacterial Pathogenesis; Immunology
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This chapter reviews both the direct and indirect effects of the introduction of pneumococcal conjugate vaccine into routine use. At this time, available data on vaccine impact are primarily from the United States, reflecting the timing of vaccine introduction. Reports from several sources indicate that the routine use of pneumococcal conjugate vaccine had a profound effect on invasive pneumococcal disease (such as bacteremia, bacteremic pneumonia, and meningitis) in children and that the effect occurred quickly following introduction. The shortages of pneumococcal conjugate vaccine that occurred between 2001 and 2004 meant that many children received an abbreviated two-dose series, received the primary three-dose series without the fourth (booster) dose, or experienced delays in the scheduled administration of doses. Pneumococci are generally transmitted from persons carrying pneumococci in the nasopharynx to others who become carriers; a small percentage of the new carriers will go on to develop disease. The reduction in carriage of vaccine serotypes in children who have received pneumococcal conjugate vaccine means that fewer vaccine serotype pneumococci are circulating among families, in day care centers, and in the community. Conjugate vaccines as currently designed can protect against only a limited number of the 90 pneumococcal serotypes. Data on vaccine impact on carriage and disease following routine introduction have added a wealth of information on top of that learned from clinical trials.
Pneumococcal carriage among children <7 years of age in Massachusetts by serotype and quarter Q1 to Q4, 2000 to 2003 ( 57 ). Solid bars, vaccine type; hatched bars, nonvaccine type; open bars, vaccine related, including serotype 19A.
Coverage with three or more doses of pneumococcal conjugate vaccine among children 19 to 35 months old according to the National Immunization Survey (NIS) and incidence of invasive pneumococcal disease among children <5 years of age by serotype in the CDC’s ABCs areas, 1998 to 2005 (CDC, unpublished data; 13 , 14 , 47 ).
Incidence of invasive pneumococcal disease among adults 65 years of age and older by serotype in the CDC’s ABCs areas, 1998 to 2005 (CDC, unpublished data; 13, 47).
Change in projected number of episodes of invasive pneumococcal disease in the United States by serotype and age group, 1998/1999 versus 2003. Data are from the CDC’s ABCs ( 13 ).
Introduction of seven-valent pneumococcal conjugate vaccine into national immunization programs, as of January 2007 a
Impact of routine pneumococcal conjugate vaccine use on incidence of invasive disease in children, by age group and serotype
Observational (retrospective) studies evaluating effectiveness of pneumococcal conjugate vaccine against invasive disease caused by vaccine serotypes in young children