Potential impact of replacing the 13-valent pneumococcal conjugate vaccine with 15-valent or 20-valent pneumococcal conjugate vaccine in the 1 + 1 infant schedule in England: a modelling study.

IF 25.4 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Public Health Pub Date : 2024-09-01 Epub Date: 2024-08-14 DOI:10.1016/S2468-2667(24)00161-0

Yoon Hong Choi, Marta Bertran, David J Litt, Shamez N Ladhani, Elizabeth Miller

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引用次数: 0

Abstract

Background: Paediatric pneumococcal conjugate vaccine (PCV) programmes in England using seven-valent PCV (PCV7) in 2006 and 13-valent PCV (PCV13) in 2010 have reduced vaccine-type invasive pneumococcal disease, but the overall effect has been reduced by an increase in invasive pneumococcal disease due to non-vaccine serotypes and serotype 3. We developed pneumococcal transmission models to investigate the potential effect on invasive pneumococcal disease of higher valency PCVs covering an additional two (ie, 15-valent PCV [PCV15]) or seven serotypes (ie, 20-valent PCV [PCV20]) in England.

Methods: We conducted a modelling study using realistic, age-structured, and compartmental deterministic models fitted to carriage data from before the introduction of PCVs and invasive pneumococcal disease data from before and after the introduction of PCV7 and PCV13 in England from the UK Heath Security Agency invasive pneumococcal disease surveillance system. We estimated key parameters, including PCV7 and PCV13 efficacy against vaccine-type carriage and invasiveness of PCV7 serotypes; the additional serotypes in PCV13, PCV15 and PCV20; and non-vaccine serotypes. We simulated the effect of transitioning from PCV13 to PCV15 or PCV20 in infants under the current 1 + 1 vaccination schedule and investigated the effect of reduced carriage protection against PCV13 serotypes due to attenuation of immunogenicity in higher valency vaccines.

Findings: Our results suggest that PCV15 might increase overall invasive pneumococcal disease as the reduction in vaccine-type invasive pneumococcal disease would be counterbalanced by an increase in non-PCV15 invasive pneumococcal disease. By contrast, PCV20 is projected to have a substantial impact on overall invasive pneumococcal disease due to higher invasiveness of the additional serotypes covered by PCV20 than the replacing non-vaccine serotypes. Reduced carriage protection against PCV13 serotypes with higher valency vaccines would amplify these effects.

Interpretation: Replacing PCV13 with PCV20 is likely to have a substantial public health benefit, but PCV15 could potentially increase the overall burden of disease.

Funding: UK Health Security Agency and National Institute of Health Research.

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英国婴儿 1+1 接种程序中用 15 价或 20 价肺炎球菌结合疫苗取代 13 价肺炎球菌结合疫苗的潜在影响：一项模拟研究。

背景：英格兰的儿科肺炎球菌结合疫苗 (PCV) 计划在 2006 年使用七价 PCV (PCV7)，在 2010 年使用十三价 PCV (PCV13)，减少了疫苗型侵袭性肺炎球菌疾病，但由于非疫苗血清型和血清型 3 导致的侵袭性肺炎球菌疾病增加，整体效果有所减弱。我们开发了肺炎球菌传播模型，以研究更高价肺炎球菌疫苗（即 15 价肺炎球菌疫苗 [PCV15]）或 7 种血清型（即 20 价肺炎球菌疫苗 [PCV20]）在英格兰对侵入性肺炎球菌疾病的潜在影响：我们利用英国卫生安全局侵入性肺炎球菌疾病监测系统提供的英格兰 PCV7 和 PCV13 引入前和引入后的携带数据以及侵入性肺炎球菌疾病数据，采用现实、年龄结构和分区确定性模型进行了建模研究。我们估算了关键参数，包括 PCV7 和 PCV13 对疫苗型携带的有效性和 PCV7 血清型的侵袭性；PCV13、PCV15 和 PCV20 中新增的血清型；以及非疫苗血清型。我们模拟了现行 1+1 疫苗接种计划下婴儿从 PCV13 过渡到 PCV15 或 PCV20 的效果，并研究了高价疫苗免疫原性衰减导致 PCV13 血清型带菌保护降低的影响：我们的研究结果表明，PCV15 可能会增加侵袭性肺炎球菌疾病的发病率，因为非 PCV15 侵袭性肺炎球菌疾病的增加会抵消疫苗型侵袭性肺炎球菌疾病的减少。相比之下，由于 PCV20 所覆盖的额外血清型的侵袭性高于替代的非疫苗血清型，因此 PCV20 预计会对总体侵袭性肺炎球菌疾病产生重大影响。使用效价更高的疫苗对 PCV13 血清型的带菌保护降低，将扩大这些影响：用 PCV20 取代 PCV13 可能会带来巨大的公共卫生效益，但 PCV15 有可能会增加疾病的总体负担：资金来源：英国卫生安全局和英国国家卫生研究院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

55.60

自引率

0.80%

发文量

305

审稿时长

8 weeks

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