BACKGROUND: Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies. METHODS: For each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011-2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 - IRR)*100. RESULTS: After five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI -4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI -8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20-29% and 32-53% of IPD cases in PCV13 and PCV10 sites, respectively. CONCLUSION: Overall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative.

Antwerp University Antwerp Belgium

CIBER Epidemiología y Salud Pública Madrid Spain

Department of Clinical Microbiology Karolinska University Hospital Stockholm Sweden

Department of Microbiology Tumor and Cell Biology Karolinska Institutet Stockholm Sweden

EpiConcept Paris France

European Centre for Disease Prevention and Control Stockholm Sweden

General Directorate of Public Health Madrid Spain

Health Protection Scotland National Services Scotland Glasgow UK

Health Protection Surveillance Centre Dublin Ireland

Instituto de Recerca Pediátrica Hospital Sant Joan de Deu Universitat Internacional de Catalunya Barcelona Spain

Instituto de Salud Pública de Navarra IdiSNA Pamplona Spain

Irish Pneumococcal Reference Laboratory Temple Street Children's University Hospital Dublin Ireland

National Centre for Pneumococci European Hospital George Pompidou Paris France

National Institute for Health and Welfare Helsinki Finland

National Institute for Public Health and the Environment Bilthoven The Netherlands

National Institute of Public Health Prague Czech Republic

Netherlands Reference Laboratory for Bacterial Meningitis Academic Medical Centre Amsterdam The Netherlands

Norwegian Institute of Public Health Oslo Norway

Public Health Agency of Catalunya Barcelona Spain

Public Health Agency of Sweden Solna Sweden

Public Health England London UK

Santé publique France Saint Maurice France

Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory Glasgow UK

Statens Serum Institut Copenhagen Denmark

University of Tampere Tampere Finland

doi: 10.1136/thoraxjnl-2018-212585 PubMed

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