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Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program

Sunday, 15th of May 2016

Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program ☆

Marta Moreiraa, , ,

Otavio Cintrab,

Julie Harriaguec,

William P. Hausdorffa,

Bernard Hoeta

a GSK Vaccines, Wavre, Belgium

b GSK Vaccines, Rio de Janeiro, Brazil

c 4Clinics, Paris, France

Received 18 December 2015, Revised 18 March 2016, Accepted 4 April 2016, Available online 22 April 2016

Abstract below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X16301268

Brazil introduced the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix™, GSK Vaccines) in the routine childhood immunization program in 2010 with a 3 + 1 schedule (with catch-up for children <2 years-old). This review represents the first analysis of the overall impact of a second-generation pneumococcal conjugate vaccine on nasopharyngeal carriage and all the major pneumococcal disease manifestations in a single, pneumococcal conjugate vaccine-naïve, developing country. A total of 15 published articles and 13 congress abstracts were included in the analysis. In children <5 years-old, studies showed a positive impact of PHiD-CV on the incidence of vaccine-type and any-type invasive pneumococcal disease (including decreases in pneumococcal meningitis morbidity and mortality), on pneumonia incidence and mortality, and on otitis media. Nasopharyngeal carriage of vaccine-type and any-type pneumococci decreased after the primary doses, with no early signs of replacement with other pathogens. Finally, herd protection against vaccine-type invasive pneumococcal disease and pneumonia in unvaccinated subjects was shown in some studies for some age groups. In conclusion, pneumococcal disease decreased after the introduction of PHiD-CV into the Brazilian national immunization program. Further follow-up is needed to evaluate the long-term overall impact of PHiD-CV in the Brazilian population.

Abbreviations

AOM, acute otitis media;

CI, confidence interval;

CVE, Centro de Vigilância Epidemiológica;

IAL, Instituto Adolfo Lutz;

IPD, invasive pneumococcal disease;

NS, statistically non-significant;

NTHi, non-typeable Haemophilus influenzae;

NVT, non-vaccine type;

PCV, pneumococcal conjugate vaccine;

PHiD-CV, pneumococcal Haemophilus influenzae protein D conjugate vaccine;

PM, pneumococcal meningitis;

RCTs, randomized controlled trials;

SINAN, Notifiable Diseases Information System;

VE, vaccine effectiveness;

VT, vaccine-type

Keywords

Streptococcus pneumoniae;

Brazil;

Invasive pneumococcal disease;

Pneumonia;

Acute otitis media;

Nasopharyngeal carriage