Real world impact of 13vPCV in preventing invasive pneumococcal pneumonia in Australian children: A national study

Nusrat Homaira; Roxanne Strachan; Helen Quinn; Sean Beggs; Mejbah Bhuiyan; Asha Bowen; Laura K Fawcett; Gwendolyn L Gilbert; Stephen B Lambert; Kristine Macartney; Helen S Marshall; Andrew C Martin Md; Gabrielle McCallum; Angela McCullagh; Tim McDonald; Hiran Selvadurai; Peter McIntyre; Shahin Oftadeh; Sarath Ranganathan PhD; Thomas Saunders; Sadasivam Suresh; Claire Wainwright; Angela Wilson; Melanie Wong; Adam Jaffe; Tom Snelling

doi:10.1016/j.vaccine.2022.11.006

Real world impact of 13vPCV in preventing invasive pneumococcal pneumonia in Australian children: A national study

Vaccine. 2023 Jan 4;41(1):85-91. doi: 10.1016/j.vaccine.2022.11.006. Epub 2022 Nov 16.

Authors

Nusrat Homaira¹, Roxanne Strachan², Helen Quinn³, Sean Beggs⁴, Mejbah Bhuiyan⁵, Asha Bowen⁵, Laura K Fawcett⁶, Gwendolyn L Gilbert⁷, Stephen B Lambert⁸, Kristine Macartney⁹, Helen S Marshall¹⁰, Andrew C Martin Md¹¹, Gabrielle McCallum¹², Angela McCullagh¹³, Tim McDonald¹⁴, Hiran Selvadurai¹⁵, Peter McIntyre¹⁶, Shahin Oftadeh¹⁷, Sarath Ranganathan PhD¹⁸, Thomas Saunders¹⁹, Sadasivam Suresh²⁰, Claire Wainwright²⁰, Angela Wilson²¹, Melanie Wong¹⁵, Adam Jaffe⁶, Tom Snelling²²

Affiliations

¹ Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, UNSW Sydney, NSW, Australia; Respiratory Department, Sydney Children's Hospital Randwick, NSW, Australia. Electronic address: n.homaira@unsw.edu.au.
² Respiratory Department, Sydney Children's Hospital Randwick, NSW, Australia.
³ National Centre for Immunisation Research and Surveillance (NCIRS), Sydney Children's Hospital's Network, Westmead, NSW, Australia.
⁴ Paediatric Department, Royal Hobart Hospital, Hobart, TAS, Australia; School of Medicine, University of Tasmania, Tasmania, Australia.
⁵ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
⁶ Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, UNSW Sydney, NSW, Australia; Respiratory Department, Sydney Children's Hospital Randwick, NSW, Australia.
⁷ Infectious Diseases Department Perth Children's Hospital, Perth Australia.
⁸ Centre for Infectious Diseases-Public Health, Institute of Clinical Pathology and Medical Research, Westmead, NSW, Australia; Children's Health Queensland, Queensland Paediatric Infectious Diseases Laboratory, Brisbane, Queensland, Australia.
⁹ National Centre for Immunisation Research and Surveillance (NCIRS), Sydney Children's Hospital's Network, Westmead, NSW, Australia; UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Women's and Children's Health Network, North Adelaide, SA, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
¹¹ Department of General Paediatrics, Perth's Children Hospital, Perth, Western Australia, Australia.
¹² Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
¹³ Department of Respiratory Medicine, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
¹⁴ The Centenary Hospital, Canberra, Australia.
¹⁵ The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹⁶ National Centre for Immunisation Research and Surveillance (NCIRS), Sydney Children's Hospital's Network, Westmead, NSW, Australia; Women's and Children's Health, University of Otago-Dunedin Campus, Dunedin, New Zealand.
¹⁷ Pneumococcal Reference Laboratory, Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia.
¹⁸ Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
¹⁹ Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
²⁰ Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia; Respiratory and Sleep Medicine, Children's Health Queensland Hospital and Health Service , Queensland Children's Hospital, South Brisbane, Queensland, Australia.
²¹ Department of Paediatrics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
²² Faculty of Medicine and Health School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 36400662
DOI: 10.1016/j.vaccine.2022.11.006

Abstract

Background: We aimed to assess the direct protective effect of 13 valent pneumococcal conjugate vaccine (13vPCV) against invasive pneumococcal pneumonia (IPP; including pneumonia and empyema) in children using a nation-wide case-control study across 11 paediatric tertiary hospitals in Australia.

Methods: Children < 18 years old admitted with pneumonia were eligible for enrolment. IPP was defined as Streptococcus pneumoniae (SP) cultured or detected by polymerase chain reaction (PCR) from blood or pleural fluid. Causative SP serotype (ST) was determined from blood or pleural fluid SP isolates by molecular methods in PCR positive specimens or else inferred from nasopharyngeal isolates. For each IPP case, 20 population controls matched by age and socio-economic status were sampled from the Australian Immunisation Register. Conditional logistic regression was used to estimate the adjusted odds ratio (aOR) of being fully vaccinated with 13vPCV (≥3 doses versus < 3 doses) among IPP cases compared to controls, adjusted for sex and Indigenous status.

Results: From February 2015 to September 2018, we enrolled 1,168 children with pneumonia; 779 were 13vPCV-eligible and were individually matched to 15,580 controls. SP was confirmed in 195 IPP cases, 181 of whom had empyema. ST3 and ST19A were identified in 52% (102/195) and 11% (21/195) of IPP cases respectively. The aOR of being fully vaccinated with 13vPCV was 0.8 (95% CI 0.6-1.0) among IPP cases compared to matched controls.

Conclusion: We failed to identify a strong direct protective effect of 13vPCV against IPP among Australian children, where disease was largely driven by ST3.

Keywords: 13vPCV effectiveness; Children; Invasive pneumococcal pneumonia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Australia / epidemiology
Case-Control Studies
Child
Humans
Infant
Pneumococcal Infections* / epidemiology
Pneumococcal Infections* / prevention & control
Pneumococcal Vaccines
Pneumonia, Pneumococcal* / epidemiology
Pneumonia, Pneumococcal* / prevention & control
Serogroup
Streptococcus pneumoniae
Vaccines, Conjugate

Substances

Pneumococcal Vaccines
Vaccines, Conjugate