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Introduction <p>Pneumococcal conjugate vaccines (PCVs) have been increasing in valency to protect against a larger number of serotypes; however, the addition of serotypes has come at the cost of reduced immunogenicity, which may lead to breakthrough disease.</p> Methods <p>This study used a mathematical model to evaluate the impact of introducing routine vaccination with either PCV15 or PCV20 on breakthrough invasive pneumococcal disease (bIPD) incidence associated with PCV13 serotypes in infants aged 0–12&#xa0;months in France. The model incorporated historical PCV introductions and calibrated age- and serotype-specific IPD data spanning 2000–2019. Serotype-specific vaccine effectiveness for PCV15 and PCV20 was predicted based on previously published analyses. The incidence of bIPD was evaluated across three serotype classes: PCV7 (serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F), PCV13-nonPCV7-nonST3 (serotypes 1, 5, 6A, 7F, and 19A), and ST3 (serotype 3). Results were compared to IPD incidence in 2019.</p> Results <p>Twenty years following introduction into the childhood immunization program, the routine use of PCV15 in a 2 + 1 regimen led to fewer PCV13-nonPCV7-nonST3-associated bIPD cases in infants than the use of PCV20 in either a 2 + 1 or 3 + 1 regimen. PCV15 reduced bIPD incidence in all three serotype classes (–&#xa0;28% to –&#xa0;89%) in infants, with the largest impact on ST3. PCV20 in both regimens resulted in more bIPD cases from PCV7 serotypes (+ 65% to + 350%), while PCV13-nonPCV7-nonST3 and ST3 bIPD cases increased in a 2 + 1 regimen (+ 28% and + 6%, respectively) but decreased in a 3 + 1 regimen (–&#xa0;23% and –&#xa0;30%, respectively), in infants.</p> Conclusions <p>Implementation of PCV15 in a 2 + 1 regimen could reduce bIPD incidence due to all PCV13 serotypes in infants, whereas PCV20 in a 2 + 1 regimen may lead to substantial increases in bIPD cases from PCV13 serotypes in infants. PCV20 in a 3 + 1 regimen could potentially lead to a resurgence of bIPD from PCV7 serotypes in infants.</p>

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PCV13-Serotype Breakthrough Pneumococcal Disease in Infants Receiving High-Valency Conjugate Vaccines: Population-Level Modeling in France

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月19日

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  • Kevin M. Bakker,
  • Rachel J. Oidtman,
  • Natalie Banniettis,
  • Kristen Feemster,
  • Priscilla Velentgas,
  • Tufail M. Malik,
  • Giulio Meleleo,
  • Jessica Weaver

摘要

Introduction

Pneumococcal conjugate vaccines (PCVs) have been increasing in valency to protect against a larger number of serotypes; however, the addition of serotypes has come at the cost of reduced immunogenicity, which may lead to breakthrough disease.

Methods

This study used a mathematical model to evaluate the impact of introducing routine vaccination with either PCV15 or PCV20 on breakthrough invasive pneumococcal disease (bIPD) incidence associated with PCV13 serotypes in infants aged 0–12 months in France. The model incorporated historical PCV introductions and calibrated age- and serotype-specific IPD data spanning 2000–2019. Serotype-specific vaccine effectiveness for PCV15 and PCV20 was predicted based on previously published analyses. The incidence of bIPD was evaluated across three serotype classes: PCV7 (serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F), PCV13-nonPCV7-nonST3 (serotypes 1, 5, 6A, 7F, and 19A), and ST3 (serotype 3). Results were compared to IPD incidence in 2019.

Results

Twenty years following introduction into the childhood immunization program, the routine use of PCV15 in a 2 + 1 regimen led to fewer PCV13-nonPCV7-nonST3-associated bIPD cases in infants than the use of PCV20 in either a 2 + 1 or 3 + 1 regimen. PCV15 reduced bIPD incidence in all three serotype classes (– 28% to – 89%) in infants, with the largest impact on ST3. PCV20 in both regimens resulted in more bIPD cases from PCV7 serotypes (+ 65% to + 350%), while PCV13-nonPCV7-nonST3 and ST3 bIPD cases increased in a 2 + 1 regimen (+ 28% and + 6%, respectively) but decreased in a 3 + 1 regimen (– 23% and – 30%, respectively), in infants.

Conclusions

Implementation of PCV15 in a 2 + 1 regimen could reduce bIPD incidence due to all PCV13 serotypes in infants, whereas PCV20 in a 2 + 1 regimen may lead to substantial increases in bIPD cases from PCV13 serotypes in infants. PCV20 in a 3 + 1 regimen could potentially lead to a resurgence of bIPD from PCV7 serotypes in infants.