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This house believes that a 2+1
PCV schedule is preferable to a
3+0 PCV schedule in LMICs
Burden of disease caused by Streptococcus
pneumoniae in children younger than 5 years
O’Brien et al,Lancet 2009
Philosophy
a theory or attitude that acts as a guiding principle for
behaviour
This house believes that a 2+1 PCV schedule
is preferable to a 3+0 PCV schedule in LMICs
Pneumococcal schedules
• 3+0 = 6, 10 and 14 weeks
• 2+1 = 6, 14 weeks and 9 months
• 2+1 = 2, 4 months and 9/12 months
Timeliness of vaccination in 45 LMIC/LICs
Clark and Sanderson, Lancet 2009
International Vaccine Access Center
Olivia Cohen, MSPH
Maria Knoll, PhD
Kate O’Brien, MD, MPH
Meena Ramakrishnan, MD, MPH
...
RCTs Post-primary GMC
Post-primary
in 2+1 vs 3+0 %>0.2
GMC
Hamaluba et, Lancet ID al 2015
Serotype 1
Serotype 19F
Serotype 23F
RCTs Post-3rd dose % responders
Antibody at
10 months
of age after
booster in
2+1 vs
persistence
in 3+0
%>0.2
GMC
Hamaluba et, Lancet ID al 2015
Post-booster
persistence
%>0.2
GMC
Hamaluba et, Lancet ID al 2015
RCTS Carriage post”booster”
Other studies Carriage post”booster”
Post-implementation Carriage observational data
Indirect effects on carriage
Indirect effects on carriage in adults
Impact on IPD
Impact on pneumonia
3+0 and 2+1 schedules are similar in impact
WHO Position- Schedule
For administration of PCV to infants, WHO recommends a 3-dose
schedule administered either as 2p+1 ...
Philosophy vs Evidence
• Scientists generate evidence to challenge beliefs and make rational
decisions
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Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 1 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 2 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 3 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 4 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 5 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 6 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 7 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 8 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 9 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 10 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 11 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 12 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 13 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 14 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 15 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 16 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 17 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 18 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 19 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 20 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 21 Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019 Slide 22
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Debate - Pneumococcal vaccination - is a second year of life booster needed for herd protection?

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Prof Andrew Pollard @ MRF's Meningitis and Septicaemia 2019

  1. 1. This house believes that a 2+1 PCV schedule is preferable to a 3+0 PCV schedule in LMICs
  2. 2. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years O’Brien et al,Lancet 2009
  3. 3. Philosophy a theory or attitude that acts as a guiding principle for behaviour
  4. 4. This house believes that a 2+1 PCV schedule is preferable to a 3+0 PCV schedule in LMICs
  5. 5. Pneumococcal schedules • 3+0 = 6, 10 and 14 weeks • 2+1 = 6, 14 weeks and 9 months • 2+1 = 2, 4 months and 9/12 months
  6. 6. Timeliness of vaccination in 45 LMIC/LICs Clark and Sanderson, Lancet 2009
  7. 7. International Vaccine Access Center Olivia Cohen, MSPH Maria Knoll, PhD Kate O’Brien, MD, MPH Meena Ramakrishnan, MD, MPH U.S. Centers for Disease Control and Prevention Jennifer Farrar, MPH Tamara Pilishvili, PhD, MPH Cynthia Whitney, MD, MPH University College London David Goldblatt, MB.ChB, MCRP, PhD Agence de Médecine Préventive Jennifer Moisi, PhD, MPH World Health Organization HQ Monica de Cola, MPH Thomas Cherian, MD Pan-American Health Organization Lucia Helena de Oliveira, PhD, MSc Pneumococcal Conjugate Vaccine (PCV) Review of Impact Evidence (PRIME) Summary of Findings from Systematic Review https://www.who.int/immunization/sage/meetings/2017/october/02_Knoll_FINAL_PRIME_SAGEpres2017Oct16.pdf?ua=1 https://www.who.int/immunization/sage/meetings/2017/october/3_FULL_PRIME_REPORT_2017Sep26.pdf
  8. 8. RCTs Post-primary GMC
  9. 9. Post-primary in 2+1 vs 3+0 %>0.2 GMC Hamaluba et, Lancet ID al 2015
  10. 10. Serotype 1 Serotype 19F Serotype 23F RCTs Post-3rd dose % responders
  11. 11. Antibody at 10 months of age after booster in 2+1 vs persistence in 3+0 %>0.2 GMC Hamaluba et, Lancet ID al 2015
  12. 12. Post-booster persistence %>0.2 GMC Hamaluba et, Lancet ID al 2015
  13. 13. RCTS Carriage post”booster”
  14. 14. Other studies Carriage post”booster”
  15. 15. Post-implementation Carriage observational data
  16. 16. Indirect effects on carriage
  17. 17. Indirect effects on carriage in adults
  18. 18. Impact on IPD
  19. 19. Impact on pneumonia
  20. 20. 3+0 and 2+1 schedules are similar in impact
  21. 21. WHO Position- Schedule For administration of PCV to infants, WHO recommends a 3-dose schedule administered either as 2p+1 or as 3p+0, starting as early as 6 weeks of age.
  22. 22. Philosophy vs Evidence • Scientists generate evidence to challenge beliefs and make rational decisions

Debate - Pneumococcal vaccination - is a second year of life booster needed for herd protection?

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