Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study
Background: Pneumococcal disease is an important cause of childhood morbidity and mortality worldwide. Evidence is required to support the introduction of pneumococcal conjugate vaccines (PCVs) in low-income and middle-income countries (LMICs). PCVs prevent disease through both direct protection of...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-03-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X19301007 |
| _version_ | 1819090532666703872 |
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| author | Jocelyn Chan, MBBS Jana Y Lai, BScK Claire von Mollendorf, PhD Christopher Blyth, PhD David A B Dance, FRCPath Siddhartha Datta, MD Eileen M Dunne, PhD Rebecca Ford, PhD Kimberley Fox, MD Jason Hinds, PhD Keoudomphone Vilivong, MD Sophie La Vincente, PhD Deborah Lehmann, MBBS Kerryn A Moore, PhD Tuya Mungun, MD Monica L Nation, MEpi Paul N Newton, MRCP Cattram D Nguyen, PhD William Pomat, PhD Anonh Xeuatvongsa, PhD Catherine Satzke, PhD E Kim Mulholland, MD Fiona M Russell, PhD |
| author_facet | Jocelyn Chan, MBBS Jana Y Lai, BScK Claire von Mollendorf, PhD Christopher Blyth, PhD David A B Dance, FRCPath Siddhartha Datta, MD Eileen M Dunne, PhD Rebecca Ford, PhD Kimberley Fox, MD Jason Hinds, PhD Keoudomphone Vilivong, MD Sophie La Vincente, PhD Deborah Lehmann, MBBS Kerryn A Moore, PhD Tuya Mungun, MD Monica L Nation, MEpi Paul N Newton, MRCP Cattram D Nguyen, PhD William Pomat, PhD Anonh Xeuatvongsa, PhD Catherine Satzke, PhD E Kim Mulholland, MD Fiona M Russell, PhD |
| author_sort | Jocelyn Chan, MBBS |
| collection | DOAJ |
| description | Background: Pneumococcal disease is an important cause of childhood morbidity and mortality worldwide. Evidence is required to support the introduction of pneumococcal conjugate vaccines (PCVs) in low-income and middle-income countries (LMICs). PCVs prevent disease through both direct protection of vaccinated individuals, and indirect protection of unvaccinated people via reduction of nasopharyngeal carriage and transmission of vaccine-type (VT) pneumococci. We aimed to determine the degree of this indirect effect after introduction of 13-valent PCV (PCV13) at three sites in Asia-Pacific, and describe the relationship between PCV coverage and indirect protection. Methods: We are recruiting and swabbing children aged 2–59 months, admitted to participating hospitals with acute respiratory tract infections in Laos, Mongolia, and Papua New Guinea. Pneumococci are detected using lytA qPCR and serotyped by microarray. We are comparing risk of VT carriage in undervaccinated cases by village/subdistrict-level PCV13 coverage in children younger than 5 years. Individual PCV status is determined using written records and village PCV coverage is determined by administrative data or survey. Recruitment is due to finish in March, 2019. Findings: As of June, 2018, we have recruited 1208, 1056, and 897 cases, and tested 1099, 624, and 405 samples, from Laos, Mongolia, and Papua New Guinea, respectively. Overall, pneumococcal carriage varied from 37% in Laos to 88% in Papua New Guinea. In Laos, VT carriage decreased from 18% to 6% from the first to the third year post-PCV. In Papua New Guinea, VT carriage decreased from 54% to 37% from the first to the third year after PCV introduction. In Mongolia, VT carriage decreased from 31% pre-PCV to 24% in the first year after PCV. Undervaccinated children from villages with less than 50% coverage are 1·08 (95% CI 0·69–1·79) and 1·44 (95% CI 0·99–2·10) times more likely to be carrying VT than those from villages with 50% or more coverage, among the 336 in Laos and 83 children in Papua New Guinea, respectively, for whom we have both PCV and carriage data. This difference does not reach statistical significance. Interpretation: In the absence of feasible methods for pneumococcal disease surveillance in LMICs, studies of nasopharyngeal carriage of VT pneumococci, which is a prerequisite for disease, provide useful information to guide vaccine policy. The inclusion of three sites, which have contrasting vaccine schedules and pneumococcal epidemiology, enable us to explore factors that could maximise indirect protection from PCVs. Funding: Bill & Melinda Gates Foundation, Gavi the Vaccine Alliance. |
| first_indexed | 2024-12-21T22:25:20Z |
| format | Article |
| id | doaj.art-c0da270e4d6547e6a7baee94b0c32f0a |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-21T22:25:20Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-c0da270e4d6547e6a7baee94b0c32f0a2022-12-21T18:48:14ZengElsevierThe Lancet Global Health2214-109X2019-03-017S15Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational studyJocelyn Chan, MBBS0Jana Y Lai, BScK1Claire von Mollendorf, PhD2Christopher Blyth, PhD3David A B Dance, FRCPath4Siddhartha Datta, MD5Eileen M Dunne, PhD6Rebecca Ford, PhD7Kimberley Fox, MD8Jason Hinds, PhD9Keoudomphone Vilivong, MD10Sophie La Vincente, PhD11Deborah Lehmann, MBBS12Kerryn A Moore, PhD13Tuya Mungun, MD14Monica L Nation, MEpi15Paul N Newton, MRCP16Cattram D Nguyen, PhD17William Pomat, PhD18Anonh Xeuatvongsa, PhD19Catherine Satzke, PhD20E Kim Mulholland, MD21Fiona M Russell, PhD22Murdoch Children's Research Institute, Melbourne, VIC, Australia; Correspondence to: Dr Jocelyn Chan, MCRI, 50 Flemington Road, Parkville, VIC, 3052, AustraliaMurdoch Children's Research Institute, Melbourne, VIC, AustraliaMurdoch Children's Research Institute, Melbourne, VIC, AustraliaUniversity of Western Australia, Perth, WA, AustraliaLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, LaosWHO, Manila, PhilippinesMurdoch Children's Research Institute, Melbourne, VIC, AustraliaPapua New Guinea Institute of Medical Research, Goroka, Papua New GuineaWHO, Manila, PhilippinesSt-George's University of London, London, UKLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, LaosMurdoch Children's Research Institute, Melbourne, VIC, AustraliaUniversity of Western Australia, Perth, WA, AustraliaMurdoch Children's Research Institute, Melbourne, VIC, AustraliaMinistry of Health, Ulaanbaatar, MongoliaMurdoch Children's Research Institute, Melbourne, VIC, AustraliaLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, LaosMurdoch Children's Research Institute, Melbourne, VIC, AustraliaPapua New Guinea Institute of Medical Research, Goroka, Papua New GuineaMinistry of Health, Vientiane, LaosMurdoch Children's Research Institute, Melbourne, VIC, AustraliaMurdoch Children's Research Institute, Melbourne, VIC, AustraliaMurdoch Children's Research Institute, Melbourne, VIC, AustraliaBackground: Pneumococcal disease is an important cause of childhood morbidity and mortality worldwide. Evidence is required to support the introduction of pneumococcal conjugate vaccines (PCVs) in low-income and middle-income countries (LMICs). PCVs prevent disease through both direct protection of vaccinated individuals, and indirect protection of unvaccinated people via reduction of nasopharyngeal carriage and transmission of vaccine-type (VT) pneumococci. We aimed to determine the degree of this indirect effect after introduction of 13-valent PCV (PCV13) at three sites in Asia-Pacific, and describe the relationship between PCV coverage and indirect protection. Methods: We are recruiting and swabbing children aged 2–59 months, admitted to participating hospitals with acute respiratory tract infections in Laos, Mongolia, and Papua New Guinea. Pneumococci are detected using lytA qPCR and serotyped by microarray. We are comparing risk of VT carriage in undervaccinated cases by village/subdistrict-level PCV13 coverage in children younger than 5 years. Individual PCV status is determined using written records and village PCV coverage is determined by administrative data or survey. Recruitment is due to finish in March, 2019. Findings: As of June, 2018, we have recruited 1208, 1056, and 897 cases, and tested 1099, 624, and 405 samples, from Laos, Mongolia, and Papua New Guinea, respectively. Overall, pneumococcal carriage varied from 37% in Laos to 88% in Papua New Guinea. In Laos, VT carriage decreased from 18% to 6% from the first to the third year post-PCV. In Papua New Guinea, VT carriage decreased from 54% to 37% from the first to the third year after PCV introduction. In Mongolia, VT carriage decreased from 31% pre-PCV to 24% in the first year after PCV. Undervaccinated children from villages with less than 50% coverage are 1·08 (95% CI 0·69–1·79) and 1·44 (95% CI 0·99–2·10) times more likely to be carrying VT than those from villages with 50% or more coverage, among the 336 in Laos and 83 children in Papua New Guinea, respectively, for whom we have both PCV and carriage data. This difference does not reach statistical significance. Interpretation: In the absence of feasible methods for pneumococcal disease surveillance in LMICs, studies of nasopharyngeal carriage of VT pneumococci, which is a prerequisite for disease, provide useful information to guide vaccine policy. The inclusion of three sites, which have contrasting vaccine schedules and pneumococcal epidemiology, enable us to explore factors that could maximise indirect protection from PCVs. Funding: Bill & Melinda Gates Foundation, Gavi the Vaccine Alliance.http://www.sciencedirect.com/science/article/pii/S2214109X19301007 |
| spellingShingle | Jocelyn Chan, MBBS Jana Y Lai, BScK Claire von Mollendorf, PhD Christopher Blyth, PhD David A B Dance, FRCPath Siddhartha Datta, MD Eileen M Dunne, PhD Rebecca Ford, PhD Kimberley Fox, MD Jason Hinds, PhD Keoudomphone Vilivong, MD Sophie La Vincente, PhD Deborah Lehmann, MBBS Kerryn A Moore, PhD Tuya Mungun, MD Monica L Nation, MEpi Paul N Newton, MRCP Cattram D Nguyen, PhD William Pomat, PhD Anonh Xeuatvongsa, PhD Catherine Satzke, PhD E Kim Mulholland, MD Fiona M Russell, PhD Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study The Lancet Global Health |
| title | Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study |
| title_full | Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study |
| title_fullStr | Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study |
| title_full_unstemmed | Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study |
| title_short | Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study |
| title_sort | determining the pneumococcal conjugate vaccine coverage required for indirect protection within asia and the pacific a prospective observational study |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X19301007 |
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