Pneumokokkirokotteen vaikutus vakavaan pneumokokkitautiin rokotetuilla

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Pneumokokkikonjugaattirokotteen vaikutus vakavan pneumokokkitaudin ilmaantuvuuteen rokotetuilla Suomen kansallisessa rokotusohjelmassa. Esitys Euroopan lasten infektiotautijärjestön (ESPID) kokouksessa Milanossa 30.5.2013

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Pneumokokkirokotteen vaikutus vakavaan pneumokokkitautiin rokotetuilla

  1. 1. IMPACT OF10-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV10)AGAINST INVASIVE PNEUMOCOCCAL DISEASE (IPD)AMONG VACCINE - ELIGIBLE CHILDREN IN FINLANDHanna Rinta-KokkoMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 1
  2. 2. Disclosure•  H. Rinta-Kokko is a co-investigator in the effectiveness studyof the 10-valent pneumococcal conjugate vaccine (FinIP)funded by GlaxoSmithKline Biologicals SA and NationalInstitute for Health and Welfare (THL)May 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 2
  3. 3. Background•  10-valent pneumococcal conjugate vaccine (PCV10) wasintroduced into the Finnish National Vaccination Programme(NVP) in September 2010•  Nordic schedule 2+1: 3, 5 and 12 months of age•  No catch-up for children older than 3 months•  Estimated uptake: 95%May 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 3
  4. 4. Background: PCV introduction in Finland•  PCV7 was licensed by EMA in February 2001•  In 2002, introduction of PCV7 was considered–  Cost effectiveness analysis of 3+1 schedule unfavorable•  In 2008, cost effectiveness analysis with 2+1 schedule andindirect impact–  Favorable: PCV was recommened to NVP•  Based on public tender, PCV10 was selected•  Before introduction to NVP, the use of PCVs was minimal,~1 % of target groupMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 4
  5. 5. Background: PCV uptake before NVP –PCV10-trial (FinIP) 2009-2010•  Finnish InvasivePneumococcal diseasevaccination trial•  Community-randomiseddouble-blinded trial•  Recruitment period Feb2009 to Aug 2010•  80% of Finnish health carecenters, almost 50 000participants•  2/3 of clusters PCV10, 1/3control•  Study time-period excludedfrom NVP impact analysesMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 5Palmu et al. Lancet 2013
  6. 6. National surveillance of invasivepneumococcal disease (IPD) in Finland•  National Infectious Disease Register•  Population-based laboratory surveillance system since 1995•  Isolates collected and serotyped by THL•  S. Pneumoniae isolated from blood or cerebrospinal fluid•  Population register data are used as denominators tocalculate annual, age- and serotype group -specificincidence ratesMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 6
  7. 7. Annual overall incidence of IPDamong children < 2 years of age, FinlandMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 7IncidenceofIPD/100000person-yearsYear
  8. 8. Annual incidence of PCV10-type IPDamong children < 2 years of age, FinlandMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 8IncidenceofIPD/100000person-yearsYear
  9. 9. Annual incidence of PCV10-related type* IPDamong children < 2 years of age, FinlandMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 9IncidenceofIPD/100000person-yearsFinIPNVPFinIPNVPFinIPNVNVPFinIP* 6A, 6C, 6D, 7B, 7C, 9N, 18B, 18F, 19A, 23A, 23BYear
  10. 10. Annual incidence of non-PCV10 type IPDamong children < 2 years of age, FinlandMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 10IncidenceofIPD/100000person-yearsFinIPNVPFinIPNVPFinIPNVPNVPFinIPYear
  11. 11. Material and methods•  Population-based cohortstudy–  Target cohort: childreneligible for NVP (born June1, 2010 or later)–  Two season- and age-matched reference cohortsfor before-after comparison•  Register data–  National Infectious DiseaseRegister•  IPD cases for each cohort bybirth date and sample date–  Population Register•  Population denominators fortarget and reference birthcohorts–  > Calculation of incidencerates for the cohortsMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 11
  12. 12. Methods: Target and reference cohortsMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 12Age(years)Target cohort 2010 to 2012Reference cohort 2004 to 2006Reference cohort 2006 to 2008YearFinIPNVPAge:3-29 months
  13. 13. Results: incidence rates/100 000 person-years(N) of IPD in target and reference cohortsMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 13Referencecohort2004-2006(N=135987)Referencecohort2006-2008(N=138489)ReferencecohortscombinedTargetcohort2010-2012(N=142206)Relative ratereduction(95%CI):Target vs. ref.cohortscombinedPCV10serotypes56.3 (89) 42.2 (68) 49.2 (157) 6.7 (11) 87 (76, 93)PCV10-relatedserotypes5.7 (9) 8.1 (13) 6.9 (22) 0.6 (1) 91 (58, 100)Non-PCV10serotypes5.1 (8) 2.5 (4) 3.8 (12) 4.8 (8) -29 (-211, 50)Undefined 2.5 (4) 1.2 (2) 1.9 (6) 0 (0) 100 (95, 100)Any cultureconfirmed69.5 (110) 54 (87) 61.9 (197) 12.1 (20) 80 (70, 88)
  14. 14. Results: incidence rates/100 000 person-years(N) of IPD in target and reference cohortsMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 14Referencecohort2004-2006(N=135987)Referencecohort2006-2008(N=138489)ReferencecohortscombinedTargetcohort2010-2012(N=142206)Relative ratereduction(95%CI):Target vs. ref.cohortscombinedPCV10serotypes56.3 (89) 42.2 (68) 49.2 (157) 6.7 (11) 87 (76, 93)PCV10-relatedserotypes5.7 (9) 8.1 (13) 6.9 (22) 0.6 (1) 91 (58, 100)Non-PCV10serotypes5.1 (8) 2.5 (4) 3.8 (12) 4.8 (8) -29 (-211, 50)Undefined 2.5 (4) 1.2 (2) 1.9 (6) 0 (0) 100 (95, 100)Any cultureconfirmed69.5 (110) 54 (87) 61.4 (197) 12.1 (20) 80 (67, 88)
  15. 15. Results: incidence rates/100 000 person-years(N) of IPD in target and reference cohortsMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 15Referencecohort2004-2006(N=135987)Referencecohort2006-2008(N=138489)ReferencecohortscombinedTargetcohort2010-2012(N=142206)Relative ratereduction(95%CI):Target vs. ref.cohortscombinedPCV10serotypes56.3 (89) 42.2 (68) 49.2 (157) 6.7 (11) 87 (76, 93)PCV10-relatedserotypes5.7 (9) 8.1 (13) 6.9 (22) 0.6 (1) 91 (58, 100)Non-PCV10serotypes5.1 (8) 2.5 (4) 3.8 (12) 4.8 (8) -29 (-211, 50)Undefined 2.5 (4) 1.2 (2) 1.9 (6) 0 (0) 100 (95, 100)Any cultureconfirmed69.5 (110) 54 (87) 61.4 (197) 12.1 (20) 80 (67, 88)
  16. 16. Results: incidence rates/100 000 person-years(N) of IPD in target and reference cohortsMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 16Referencecohort2004-2006(N=135987)Referencecohort2006-2008(N=138489)ReferencecohortscombinedTargetcohort2010-2012(N=142206)Relative ratereduction(95%CI):Target vs. ref.cohortscombinedPCV10serotypes56.3 (89) 42.2 (68) 49.2 (157) 6.7 (11) 87 (76, 93)PCV10-relatedserotypes5.7 (9) 8.1 (13) 6.9 (22) 0.6 (1) 91 (58, 100)Non-PCV10serotypes5.1 (8) 2.5 (4) 3.8 (12) 4.8 (8) -29 (-211, 50)Undefined 2.5 (4) 1.2 (2) 1.9 (6) 0 (0) 100 (95, 100)Any cultureconfirmed69.5 (110) 54 (87) 61.4 (197) 12.1 (20) 80 (67, 88)
  17. 17. Limitations•  Time frame still fairly short to evaluate the impact ofvaccination on the incidence of serotype-specific or non-PCV10 -type invasive pneumococcal diseaseMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 17
  18. 18. Conclusions•  We observed a significant reduction in overall and vaccinetype IPD among vaccine-eligible children after introduction toNVP•  PCV10 may also provide cross-protection against PCV10-related serogroups among vaccinated children•  Cohort analysis enabled comparison of vaccine-eligible andnon-eligible children adjusted for age and season•  Ongoing surveillance is needed to determine serotype-specific effects and potential increases in non-PCV10serotypesMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 18
  19. 19. Acknowledgments•  Coauthors:•  Jukka Jokinen•  Lotta Siira•  Arto Palmu•  Mikko Virtanen•  Hanna Nohynek•  Anni Virolainen-Julkunen•  Pekka NuortiMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 19
  20. 20. Back-up slidesMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 20
  21. 21. Results: incidence rates/100 000 person-years(N) of IPD in target and reference cohorts – 19AMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 21Referencecohort2004-2006(N=135987)Referencecohort2006-2008(N=138489)ReferencecohortscombinedTargetcohort2010-2012(N=142206)Relative ratereduction(95%CI):Target vs. ref.cohortscombined19A 2.5 (4) 4.3 (7) 3.8 (11) 0 (0) 100 (23,100)
  22. 22. Incidence of IPD by age-monthMay 2013 22Age (months)Incidence/100000person-years
  23. 23. Vaccine coverage (1st dose) in vaccine eligiblechildren during NVP in Vantaa, FinlandMay 2013 PCV10 direct impact on IPD / H.Rinta-Kokko 232010 2011 2012VANTAA 31%(95% CI: 29…33)94%(95% CI: 93…95)94%(95% CI: 93…95)

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