Vaccine 33 (2015) 2684–2689
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Effectiveness of three pneumococcal conjugate vaccines to prevent invasive pneumococcal disease in Quebec, Canada Geneviève Deceuninck a , Gaston De Serres a,b,c , Nicole Boulianne a,b , Brigitte Lefebvre d , Philippe De Wals a,b,c,∗ a
Quebec University Hospital Research Centre, Quebec City, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Quebec City, Canada c Department of Social and Preventive Medicine, Laval University, Quebec City, Canada d Laboratoire de Santé publique du Québec, Institut national de santé publique du Québec, Ste-Anne–de-Bellevue, Canada b
a r t i c l e
i n f o
Article history: Received 14 January 2015 Received in revised form 25 March 2015 Accepted 2 April 2015 Available online 15 April 2015 Keywords: Invasive pneumococcal disease Pneumococcal conjugate vaccine Effectiveness Case–control study
a b s t r a c t Background: In Quebec, a pneumococcal conjugate vaccine (PCV) program was implemented in December 2004. The recommended schedule is 2 + 1 doses for low-risk infants. PCV-7 was first used (including catch-up for children 90% of children received the recommended number of doses. Objective: To assess the effectiveness of the three PCVs sequentially used to prevent invasive infectious disease (IPD). Methods: IPD cases in children 2–59 months during the years 2005–2013 were eligible. Controls were randomly identified in the provincial health insurance registry. Parents were interviewed and immunization records reviewed. Vaccine effectiveness (VE) was computed using multivariate logistic regression models. Results: Out of 889 IPD cases reported, full participation was obtained for 516 cases (58%) and for 1767 controls. Against vaccine-type IPD, VE (≥1 dose) was 90% (82–95%) for PCV7, 97% (84–99%) for PCV10 and 86% (62–95%) for PCV13. Against 19A IPD, VE was, respectively, 42% (−9% to 69%), 71% (24–89%), and 74% (11–92%). VE (≥2 doses) against PCV13-type IPD was 85% for PCV10 (66–94%), 85% for PCV13 (55–94%), and 89% (58–97%) for a mixed PCV10 + PCV13 schedule. Conclusions: All three PCV vaccines showed high level of protection against IPD caused by serotypes included in their formulation and there was a high level of cross-protection against 19A for PCV10. No substantial difference was seen between PCV10, PCV13, or a mixed PCV10 + PCV13 schedule. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction Invasive pneumococcal disease (IPD) constitutes a public health problem worldwide [1]. In Canada, the 7-valent CRM197 pneumococcal conjugate vaccine (PCV7) was licensed in May 2001. In the province of Quebec, high-risk children and those living in Nordic regions were offered a four (3 + 1) dose schedule of PCV7 starting in October 2002 [2]. Quebec was the first jurisdiction in the world to recommend a 3-dose (2 + 1) schedule for the routine immunization of infants, vaccines being offered respectively, at age
∗ Corresponding author at: Département de médecine sociale et préventive, Université Laval, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada. Tel.: +1 418 656 8711; fax: +1 418 656 4614. E-mail address: [email protected] (P. De Wals). http://dx.doi.org/10.1016/j.vaccine.2015.04.005 0264-410X/© 2015 Elsevier Ltd. All rights reserved.
2, 4 and 12 months [3]. This publicly funded program was launched in December 2004, along with a catch-up program consisting of 2 doses for 12–23 month-old children and 1 dose for 2–5 year-old children. Vaccine uptake was low (
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Effectiveness of three pneumococcal conjugate vaccines to prevent invasive pneumococcal disease in Quebec, Canada Geneviève Deceuninck a , Gaston De Serres a,b,c , Nicole Boulianne a,b , Brigitte Lefebvre d , Philippe De Wals a,b,c,∗ a
Quebec University Hospital Research Centre, Quebec City, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Quebec City, Canada c Department of Social and Preventive Medicine, Laval University, Quebec City, Canada d Laboratoire de Santé publique du Québec, Institut national de santé publique du Québec, Ste-Anne–de-Bellevue, Canada b
a r t i c l e
i n f o
Article history: Received 14 January 2015 Received in revised form 25 March 2015 Accepted 2 April 2015 Available online 15 April 2015 Keywords: Invasive pneumococcal disease Pneumococcal conjugate vaccine Effectiveness Case–control study
a b s t r a c t Background: In Quebec, a pneumococcal conjugate vaccine (PCV) program was implemented in December 2004. The recommended schedule is 2 + 1 doses for low-risk infants. PCV-7 was first used (including catch-up for children 90% of children received the recommended number of doses. Objective: To assess the effectiveness of the three PCVs sequentially used to prevent invasive infectious disease (IPD). Methods: IPD cases in children 2–59 months during the years 2005–2013 were eligible. Controls were randomly identified in the provincial health insurance registry. Parents were interviewed and immunization records reviewed. Vaccine effectiveness (VE) was computed using multivariate logistic regression models. Results: Out of 889 IPD cases reported, full participation was obtained for 516 cases (58%) and for 1767 controls. Against vaccine-type IPD, VE (≥1 dose) was 90% (82–95%) for PCV7, 97% (84–99%) for PCV10 and 86% (62–95%) for PCV13. Against 19A IPD, VE was, respectively, 42% (−9% to 69%), 71% (24–89%), and 74% (11–92%). VE (≥2 doses) against PCV13-type IPD was 85% for PCV10 (66–94%), 85% for PCV13 (55–94%), and 89% (58–97%) for a mixed PCV10 + PCV13 schedule. Conclusions: All three PCV vaccines showed high level of protection against IPD caused by serotypes included in their formulation and there was a high level of cross-protection against 19A for PCV10. No substantial difference was seen between PCV10, PCV13, or a mixed PCV10 + PCV13 schedule. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction Invasive pneumococcal disease (IPD) constitutes a public health problem worldwide [1]. In Canada, the 7-valent CRM197 pneumococcal conjugate vaccine (PCV7) was licensed in May 2001. In the province of Quebec, high-risk children and those living in Nordic regions were offered a four (3 + 1) dose schedule of PCV7 starting in October 2002 [2]. Quebec was the first jurisdiction in the world to recommend a 3-dose (2 + 1) schedule for the routine immunization of infants, vaccines being offered respectively, at age
∗ Corresponding author at: Département de médecine sociale et préventive, Université Laval, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada. Tel.: +1 418 656 8711; fax: +1 418 656 4614. E-mail address: [email protected] (P. De Wals). http://dx.doi.org/10.1016/j.vaccine.2015.04.005 0264-410X/© 2015 Elsevier Ltd. All rights reserved.
2, 4 and 12 months [3]. This publicly funded program was launched in December 2004, along with a catch-up program consisting of 2 doses for 12–23 month-old children and 1 dose for 2–5 year-old children. Vaccine uptake was low (
