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What is the best PCV schedule for LMIC?
Results from trials in Asian countries:
Nepal experience
Professor Shrijana Shrestha
Patan Academy of Health Sciences, Nepal
Nepal: PCV Introduction and schedule
• Nepal introduced PCV 10 in 2015
• The first GAVI country to introduce 2+1 schedule
• In 2010/2011 a non inferiority trial conducted to
evaluate 3+0 vs 2+1 Schedule in Nepali children
• The 2+1 schedule was equally immunogenic to
the 3+0 schedule in the early infancy with
comparatively better antibody response in the
later infancy and early childhood
Study evaluating Nepal schedule (2015-2016)
A slightly different schedule from the standard WHO
schedule was used: 6 weeks, 10 weeks and 9 month
PCV Impact assessment
↓
Impact on IPD cases (IBD surveillance)
Cases of invasive pneumococcal disease by year and age group
Impact on Pneumonia
• Proportion of pneumonia cases with end-point
consolidation (EPC) on chest radiographs declined
from 40% in the pre-vaccine period to 25% by 2018,
but rose again in 2019 to 36%.
• The increase in 2019 was most pronounced in children
>5 years of age
Impact on NP carriage in children with clinical
pneumonia
• In children < 2 years with clinical pneumonia PCV10 VT
carriage declined significantly (declined 72% by 2019).
No decrease in in older children
Impact on NP carriage among healthy children
Urban cohort
Children 6 to 59 months
Rural cohort
Children 6 to 23 months
 Short term impact of PCV 10 introduction
using the 2+1 schedule has been observed
 Continued surveillance is needed for the
long term vaccine impact assessment

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Nepal's experience with PCV 2+1 schedule and impact on disease

  • 1. What is the best PCV schedule for LMIC? Results from trials in Asian countries: Nepal experience Professor Shrijana Shrestha Patan Academy of Health Sciences, Nepal
  • 2. Nepal: PCV Introduction and schedule • Nepal introduced PCV 10 in 2015 • The first GAVI country to introduce 2+1 schedule • In 2010/2011 a non inferiority trial conducted to evaluate 3+0 vs 2+1 Schedule in Nepali children • The 2+1 schedule was equally immunogenic to the 3+0 schedule in the early infancy with comparatively better antibody response in the later infancy and early childhood
  • 3. Study evaluating Nepal schedule (2015-2016) A slightly different schedule from the standard WHO schedule was used: 6 weeks, 10 weeks and 9 month
  • 4. PCV Impact assessment ↓ Impact on IPD cases (IBD surveillance) Cases of invasive pneumococcal disease by year and age group
  • 5. Impact on Pneumonia • Proportion of pneumonia cases with end-point consolidation (EPC) on chest radiographs declined from 40% in the pre-vaccine period to 25% by 2018, but rose again in 2019 to 36%. • The increase in 2019 was most pronounced in children >5 years of age Impact on NP carriage in children with clinical pneumonia • In children < 2 years with clinical pneumonia PCV10 VT carriage declined significantly (declined 72% by 2019). No decrease in in older children
  • 6. Impact on NP carriage among healthy children Urban cohort Children 6 to 59 months Rural cohort Children 6 to 23 months  Short term impact of PCV 10 introduction using the 2+1 schedule has been observed  Continued surveillance is needed for the long term vaccine impact assessment