Impact of 2 + 1 pneumococcal conjugate vaccine program in the province of Quebec, Canada

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• 作者：Philippe De Wals^a ; ^b ; ^c ; ^{philippe.dewals@criucpq.ulaval.ca" class="auth_mail} ; ^{philippe.de.wals@ssss.gouv.qc.ca" class="auth_mail} ; Brigitte Lefebvre^d ; France Markowski^e ; Geneviè ; ve Deceuninck^c ; Fannie Defay^c ; Monique Douville-Fradet^b ; Monique Landry^e
• 关键词：Pneumococcal conjugate vaccine ; Immunization program ; Effectiveness ; Herd immunity ; Replacement
• 刊名：Vaccine
• 出版年：14 March, 2014
• 年：2014
• 卷：32
• 期：13
• 页码：1501-1506
• 全文大小：929 K

文摘

Background

Quebec was the first jurisdiction in the world to recommend a 3-dose (2 + 1) pneumococcal conjugate vaccine (PCV) schedule. The program was implemented in December 2004 with a catch-up for children <5 years. PCV-7 was first used and replaced, respectively, by PCV-10 in 2009 and by PCV-13 in 2011.

Methods

Cases of invasive pneumococcal disease (IPD) notified to public health authorities and isolates submitted to the provincial reference laboratory during the period 2000-2011 were analyzed.

Results

IPD incidence in children <5 years was 67/100,000 in 2001-2004, and decreased to 32/100,000 in 2007-2009 following PCV-7 implementation (p < 0.01). A further decrease to 24/100,000 was observed in 2010-2011 following PCV-10 introduction (p < 0.01). PCV-7 serotypes represented 82% of the total IPD cases in 2000-2004 and elimination was achieved in 2011. Main emerging serotypes were 19A and 7F. Children exposed to the PCV-10 experienced lower IPD rates and all serotypes contributed to the decline, mainly 7F and 19A. In adults, a decrease of low magnitude was observed in 2005-2006 but rates in 2007-2009 were higher than in the prevaccination period.

Conclusions

A 3-dose PCV schedule with high uptake is highly effective and should be recommended worldwide. Serotype replacement eroded benefits especially in adults. PCV-10 introduction had an effect and the impact of PCV-13 use remains to be evaluated.