Shiri, Tinevimbo, Datta, Samik, Madan, Jason, Tsertsvadze, Alexander, Royle, Pamela, Keeling, Matthew James, McCarthy, Noel D. and Petrou, Stavros (2017) Indirect effects of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease: a systematic review and meta-analysis. Lancet Global Health, 5 (1). E51-E59. doi:10.1016/S2214-109X(16)30306-0 ISSN 2214-109X.

Preview

PDF WRAP-indirect-effects-childhood-pneumococcal-conjugate-meta-analysis-Keeling-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (2171Kb) | Preview

Request Changes to record.

Abstract

Background
The full extent to which childhood pneumococcal conjugate vaccines (PCV) can indirectly reduce illness in unvaccinated populations is not known. We aimed to estimate the magnitude and timing of indirect effects of PCVs on invasive pneumococcal disease.

Methods
In this systematic review and meta-analysis, we searched bibliographic databases for non-randomised quasi-experimental or observational studies reporting invasive pneumococcal disease changes following PCV introduction in unvaccinated populations (studies published Sept 1, 2010, to Jan 6, 2016), updating the previous systematic review of the same topic (studies published Jan 1, 1994, to Sept 30, 2010). Two reviewers extracted summary data by consensus. We used a Bayesian mixed-effects model to account for between-study heterogeneity to estimate temporal indirect effects by pooling of invasive pneumococcal disease changes by serotype and serogroup.

Findings
Data were extracted from 70 studies included in the previous review and 172 additional studies, covering 27 high-income and seven middle-income countries. The predicted mean times to attaining a 90% reduction in invasive pneumococcal disease were 8·9 years (95% credible interval [CrI] 7·8–10·3) for grouped serotypes contained in the seven-valent PCV (PCV7), and 9·5 years (6·1–16·6) for the grouped six additional serotypes contained in the 13-valent PCV (PCV13) but not in PCV7. Disease due to grouped serotypes contained in the 23-valent pneumococcal polysaccharide vaccine (PPV23) decreased at similar rates per year in adults aged 19–64 years (relative risk [RR] 0·85, 95% CrI 0·75–0·95) and 65 years and older (0·87, 0·84–0·90). However, we noted no changes in either group in invasive pneumococcal disease caused by the additional 11 serotypes covered by PPV23 but not PCV13.

Interpretation
Population childhood PCV programmes will lead, on average, to substantial protection across the whole population within a decade. This large indirect protection should be considered when assessing vaccination of older age groups.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Pneumonia, Pneumococcal -- Vaccination, Lungs -- Disease -- Prevention, Vaccination of children
Journal or Publication Title:	Lancet Global Health
Publisher:	The Lancet Publishing Group
ISSN:	2214-109X
Official Date:	31 January 2017
Dates:	Date Event 31 January 2017 Published 19 October 2016 Accepted
Volume:	5
Number:	1
Page Range:	E51-E59
DOI:	10.1016/S2214-109X(16)30306-0
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	15 December 2016
Date of first compliant Open Access:	15 December 2016
Funder:	Great Britain. Department of Health (DoH)

Request changes or add full text files to a record

Repository staff actions (login required)

View Item

Downloads