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Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
Ip ddirect nvp_wspid2013_finland
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Ip ddirect nvp_wspid2013_finland

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  • 1. IMPACT OF 10-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV10) AGAINST INVASIVE PNEUMOCOCCAL DISEASE (IPD) AMONG VACCINE - ELIGIBLE CHILDREN IN FINLAND Jukka Jokinen1, Hanna Rinta-Kokko1, Lotta Siira1, Arto A. Palmu2, Mikko J. Virtanen1, Hanna Nohynek1, Maija Toropainen1, Pekka Nuorti1 National Institute for Health and Welfare, Helsinki1, and Tampere2, Finland WSPID 2013 PCV10 direct impact on IPD 1
  • 2. Disclosure • Jukka Jokinen is a co-investigator in the effectiveness study of the 10-valent pneumococcal conjugate vaccine (FinIP) funded by GlaxoSmithKline Biologicals SA and National Institute for Health and Welfare (THL), Finland PCV10 direct impact on IPD 2
  • 3. 10PCV direct impact on IPD 3
  • 4. National surveillance setting of invasive pneumococcal disease (IPD) in Finland • National Infectious Disease Register (NIDR) • • • • • Population-based surveillance system since 1995 Automated reporting from clinical microbiology laboratories Reporting mandatory by law S. pneumoniae isolated from blood or cerebrospinal fluid Species verification and serotyping of IPD isolates by THL reference laboratory (~97% of reported cases) Nearly online surveillance system covering all Finnish hospitals • Population Information System (PIS) – contains details of all permanent residents in Finland, including unique personal identity code PCV10 direct impact on IPD 4
  • 5. Pneumococcal vaccinations • 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Finnish National Vaccination Programme (NVP) in September 2010 • Nordic schedule 2+1: 3, 5 and 12 months of age • No catch-up campaign • Estimated uptake: 95% after introduction • Prior to introduction commercial use of PCVs minimal, ~1 % of target group PCV10 direct impact on IPD 5
  • 6. Pneumococcal vaccinations: PCV uptake before NVP – PCV10-trial (FinIP) 2009-2010 • Finnish Invasive Pneumococcal disease vaccination trial • Community-randomised double-blinded trial • Recruitment period Feb 2009 to Aug 2010 • ~30 000 PCV-vaccinated in 80% of Finnish health care centers in 2009-2010 FinIP recruitment cohort excluded from before-after comparison Palmu et al. Lancet 2013 PCV10 direct impact on IPD 6
  • 7. Incidence of IPD / 100 000 person-years Annual overall incidence of IPD among children < 2 years of age, Finland Year 10PCV direct impact on IPD 7
  • 8. Incidence of IPD / 100 000 person-years Annual incidence of PCV10-type IPD among children < 2 years of age, Finland Year 10PCV direct impact on IPD 8
  • 9. Incidence of IPD / 100 000 person-years Annual incidence of PCV10-related type* IPD among children < 2 years of age, Finland Year 10PCV direct impact on IPD * 6A, 6C, 6D, 7B, 7C, 9A, 9N, 18B, 18F, 19A, 19B, 19C, 23A, 23B 9
  • 10. Incidence of IPD / 100 000 person-years Annual incidence of non-PCV10 type IPD among children < 2 years of age, Finland Year 10PCV direct impact on IPD 10
  • 11. Incidence of IPD / 100 000 person-years Annual incidence of non-PCV10 type IPD among children < 2 years of age, Finland Year 10PCV direct impact on IPD 11
  • 12. Incidence of IPD / 100 000 person-years Annual incidence of non-PCV10 type IPD among children < 2 years of age, Finland Year 10PCV direct impact on IPD 12
  • 13. Annual incidence of non-PCV10 type IPD among children < 2 years of age, Finland 14 12 8 11 7 10* Incidence of IPD / 100 000 person-years N total: * ¾ of the annual follow-up Year 10PCV direct impact on IPD 13
  • 14. Methods: Study design for estimating the impact of PCV in vaccine-eligible children Population-based cohort study: • Cohorts for comparison – Target cohort: children eligible for NVP (born June 1, 2010 or later) • Disease incidence rates based on register data – National Infectious Disease Register • Note: includes also those that declined from PCV – Two season- and agematched reference cohorts prior NVP introduction • IPD cases for each cohort by birth date and sample date – Population Register • Population denominators for target and reference birth cohorts Three-year follow-up post-NVP (Sep 2010-Aug 2013) PCV10 direct impact on IPD 14
  • 15. Methods: Target and reference cohorts Target cohort 2010 to 2013 Reference cohort 2003 to 2006 NVP FinIP Age (years) Reference cohort 2005 to 2008 Age: 3-38 months Year 10PCV direct impact on IPD 15
  • 16. Results: incidence rates/100 000 person-years of IPD in target and reference cohorts Reference cohorts combined (Follow-up yrs 526020) PCV10 serotypes Target cohort 2010-2013 (Follow-up yrs 272049) Relative rate reduction (95%CI): Target vs. ref. cohorts combined 47.3 4.0 92 (85 to 96) PCV10-related serotypes 9.1 2.2 76 (48 to 91) • 19A 6.3 1.5 77 (41 to 93) • 6A/C 2.1 0.0 100 (23 to 100) Non-PCV10 serotypes 3.8 6.2 -64 (-214 to 15) Any culture confirmed 62.9 12.9 80 (72 to 86) PCV10 direct impact on IPD 16
  • 17. Follow-up of breakthrough cases • By mid-November 2013, approx 180,000 infants have been vaccinated with PCV10 in the frame of Finnish NVP • First vaccine-type IPD (19F) in a child who had received at least 2 doses of PCV10 reported in September 2013 PCV10 direct impact on IPD 17
  • 18. Conclusions • Significant reduction in overall and vaccine type IPD among vaccine-eligible children 3 years after introduction of PCV10 • PCV10 may also provide cross-protection against PCV10related serotypes among vaccinated children • Close surveillance needed to determine serotype-specific effects and potential increases in non-PCV10 serotypes • Finnish registers enable near-online follow-up and accurate calculation of IPD incidences (cohort analysis) • THL will monitor the impact of PCV10 on total disease burden (e.g. suspected IPD, pneumonia, tympanostomy, antimicrobial use) using population-based health registers PCV10 direct impact on IPD 18

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