Presentation by Germaine Hanquet during the ESCAIDE 2016 parallel session on Vaccine-preventable diseases (2) on 29 November 2016 in Stockholm, Sweden

1. Indirect effect of infant PCV10/13
vaccination on IPD in the elderly:
pooled analysis from 13 EU sites
This project has received funding
from the European Union’s Horizon 2020
research and innovation programme
under grant agreement No 634446
Germaine Hanquet, Camelia Savulescu and
SpIDnet / I-MOVE + group
ESCAIDE, Stockholm, 29 November 2016

2. SpIDnet in persons ≥65 years
Aim
 To assess the indirect effect of infant PCV10/13 on elderly IPD
 To inform decisions on pneumococcal vaccination of elderly
Method
Comparison post PCV10/13 period vs. pre-PCV10/13:
 Incidence rate ratio (IRR) of each PCV10/13 year (2011-15)
 Compared to the last pre-PCV10/13 year (2009)
 IRR per site, serotype group and vaccination year
 Meta-analysis of IRR from 13 sites, using random effects
 Heterogeneity assessed
 Stratified by vaccination policy
 Imputing for missing serotypes and sensitivity

3. Overall IPD in persons ≥65 years, 2000-15
PCV10/13
CAT: Catalonia FI: Finland MAD: Madrid NOR: Norway
CZ: Czech Republic FR: France NL: the Netherlands DK: Denmark
EW: England & Wales IE: Ireland NAV: Navarra SC: Scotland

4. Ratio of IPD incidence in ≥65 years post-PCV10/13
compared to 2009, 13 sites
-9%
-77%
-39%
+63%
No further decline in overall IPD in 2015
-14%

5. Ratio of IPD incidence in ≥65 years post-PCV10/13
compared to 2009, PCV types
-73%
-20%
+1%
PCV10 PCV7 + 1, 5 and 7F
PCV13 PCV10 + 3, 6A and 19A
-18%
Serotypes 3 and 19A: 12 sites

6. Ratio of IPD incidence in ≥65 years post-PCV10/13
compared to 2009, non-PCV types
+50%
+64%
PPV23 unique types: increase in every site: from +30% to +200% in 2015
*: serotypes not in PPV23 nor in PCV13

7. Ratio of IPD incidence in ≥65 years post-PCV10/13
compared to 2009, by vaccine policy
Larger reduction on overall IPD in sites with PCV13 universal policy
-16%
-85%
+50%
-51%
-78%
-1%
+83%
+19%
FR, DK, NO, E&W, SC, IE NL, FI, CZ (PCV10/13), SE (PCV10/13)

8. Ratio of IPD incidence in ≥65 years post-PCV10/13
compared to 2009, PCV types and by vaccine policy
Large 19A increase in 2015, in the 3 PCV10 sites (IRR 2-5)
→ cross protection of PCV10 on serotype 19A not seen in indirect effect
-77%
-38% -40%
-11%
+50%
-53%
+227%+58%

9. PCV13 and PPV23 serotypes in 2015
PCV13 serotypes PPV23 serotypes not in PCV13
-32% -6%

10. Discussion
Summary
 Limited net effect of infant PCV10/13 on overall IPD in elderly
 Reduction in PCV13 types partly countered by non-PCV13 gradual rises
 Effect declined in 2015, as incidence rose in every site
 Different effect in PCV13 / PCV10 universal sites
 PCV10 sites: lower PCV13 decline, due to 3 and 19A rises
 → remaining PCV13 disease varies according to vaccine policy
 Increase of PPV23nonPCV13 serotypes in every site
Assumptions and limitations
 Pre and post-PCV population, epidemiology and surveillance did
not change
 Heterogeneity across sites: random effect and stratified analysis

11. Conclusions and recommendations
 Potential benefit of PCV13 in elderly reduced by indirect
effect of infant vaccination:
 Remaining PCV13 disease declines rapidly
 Increase of PPV23 additional type incidence with time
 Additional benefit of adult PCV13/PPV23 vaccination
over the indirect effect of infant vaccination?
 Differs with infant vaccination policy and history
 Indirect effect to take into account in decision making
 Needs to further monitor serotype trends
 Non-PCV13 types
 19A and 3 in PCV10 countries

12. SpIDnet / I-MOVE+ pneumo teams
At the surveillance sites: Professionals from participating hospitals and laboratories in each site
Czech Republic: P. Krizova, J. Kozakova, H. Sebestova, M. Maly
Denmark: P. Valentiner-Branth, L. Espenhain, T. Dalby, Z. Harboe, HC Slotved, VF. de Casadevante,
K. Fuursted
France: A. Lepoutre, E. Belchior, C. Levy, R. Cohen, E. Varon, M.C. Ploy, J. Gaillat, D. Levy‐Bruhl
Finland: H Rinta-Kokko, J. Jokinen, P. Nuorti
Ireland: J. Mereckiene, S. Cotter, M.A. Fitzgerald, M. Corcoran, R. Cunney, H. Humphries
Netherlands: M. Knol, L. Mollema, A. Van der Ende, W. van der Hoek, G. Berbers, H. de Melker, E. Sanders
Norway: D. Vestrheim, B. Winje, M. Bergsaker
Romania: M. Pana, D. Craciun, I. Codita, V. Alexandrescu
Sweden: B. Henriques Normark, E. Morfeldt, J. Darenberg, T. Lepp, A. Lindstrand
Scotland, UK: E. McDonald, A. Smith Palmer, C. Cameron, A. Smith, B. Denham, B. Jones, J. McMenamin
England and Wales, UK: S. Ladhani, S. Collins, N. Fry
Spain: M. Viarce Torres (national level)
• Catalonia: P. Ciruela, C. Izquierdo, C. Muñoz‐Almagro, S. Broner, R. Pallarés
• Madrid: L. Garcia, P. Latasa, J. Carlos Sanz, M. Ordobas
• Navarre: M. Guevara, J. Castilla, C. Ezpeleta, A. Gil-Setas
At the ECDC: L. Pastore Celentano, R. Whittaker
At the coordination: C. Savulescu (c.savulescu@epiconcept.fr), G. Hanquet, M. Valenciano, A. Moren – EpiConcept