Jelena Vojicic, Canada

Pfizer Inc. Medical Scientific Affairs

Poster Author Of 5 e-Posters

Online Abstracts Vaccines - Impact of Vaccine programs and Serotype Replacement C2 Impact of Vaccine programs and Serotype Replacement
Online Abstracts Vaccines - Impact of Vaccine programs and Serotype Replacement C2 Impact of Vaccine programs and Serotype Replacement

Author Of 6 Presentations

UNMET NEED IN CONTROLLING INVASIVE PNEUMOCOCCAL DISEASE (IPD) AMONG CANADIAN OLDER ADULTS IN THE CONTEXT OF THE CURRENT AND POTENTIAL FUTURE PNEUMOCOCCAL VACCINATION PROGRAMS (ID 824)

Abstract

Background

In Canadian adults aged ≥65, routine pneumococcal-polysaccharide-vaccine (PPV23) use has been recommended for several decades, and 13-valent pneumococcal conjugate vaccine (PCV13) on an individual basis - since 2016. When PCV13 is administered, sequential PPV23 is recommended to broaden serotype coverage.

We aimed to assess the proportion of PCV13-, PPV23/non13-, PCV15-, and PCV20-type IPD among Canadian older adults.

Methods

Proportions of IPD due to PCV13, PPV23/non13, PCV15 and PCV20 serotypes were calculated from case counts reported, by serotype and age group, from the National Microbiology Laboratory between 2010 and 2017.

Results

Among all IPD, the contribution of PCV13-type declined from 50% (487/967) to 23% (287/1,238). PPV23/non13-type IPD increased from 25% (240/967) to 39% (487/1,238). In 2017, IPD proportions due to PCV15- and PCV20-types were 36% (447/1,238) and 52% (646/1,238) (Figure 1).

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Conclusions

Despite routine PPV23 program, increasing trend in cases and proportions of PPV23/non13-type IPD was noted during the observation period. Initial decline in PCV13-type IPD, likely an indirect effect of pediatric program, leveled off in recent years supporting the need for broad PCV13 use in older adults. PCV20, which shares 19 serotypes with PPV23, could address limitations of the PPV23 program in the ability to control vaccine-type IPD.

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CLINICAL AND ECONOMIC BURDEN ATTRIBUTABLE TO SEROTYPES INCLUDED IN FUTURE PNEUMOCOCCAL CONJUGATE VACCINES IN CANADIAN CHILDREN UNDER FIVE YEARS OF AGE (ID 236)

Abstract

Background

In Canada, higher-valence pneumococcal conjugate vaccines (PCV10, PCV13) were introduced into the routine pediatric programs in 2009/2010. Despite their impact, there remains substantial disease burden. PCVs inclusive of up to 20 serotypes (PCV20), currently in development, are expected to considerably expand pneumococcal disease coverage. Our objective was to estimate the clinical and economic burden caused by PCV20 serotypes among Canadian children under five years.

Methods

Epidemiologic, clinical, and cost data were derived or estimated from published sources (Table 1). Cases (invasive pneumococcal disease (IPD), pneumonia, acute otitis media (AOM)), mortality, and direct costs caused by PCV20 serotypes were calculated for children under 5 based on 2017 population figures and assuming IPD serotype distribution for all clinical entities.

Results

Results are summarized in Table 1. Based on our assumptions, PCV20 serotypes were estimated to cover 52% of pneumococcal disease, or a total of 102,036 annual cases. Of these, IPD represented an estimated 0.13%. Total direct attributable costs were 27 million CAD. isppd canada boi table 1.png

Conclusions

Substantial amount of morbidity from pneumococcal disease, of which IPD represents only a small proportion, could be potentially addressed by the next generation PCVs currently in development.

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CANADIAN ADULTS 50-64 YEARS OF AGE CONTRIBUTE SUBSTANTIALLY TO THE CASES OF INVASIVE PNEUMOCOCCAL DISEASE (IPD) POTENTIALLY PREVENTABLE BY THE 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (ID 1230)

Abstract

Background

In Canada, age-based recommendation for adult pneumococcal vaccination starts at 65 years (routine for PPV23, on an individual basis for PCV13). Recent literature reports large additional pneumococcal pneumonia and non-pneumonia IPD burden in Canadian adults aged 50-64 years.

Methods

Case counts of IPD by serotype and age group were obtained from published annual National Microbiology Laboratory (NML) reports of passive laboratory-based surveillance. We calculated the proportion of all IPD cases occurring in adults 50-64, ≥65, and ≥50 years of age and trends in the proportion of PCV13-type IPD in these age groups, for 2010-2017.

Results

Between 2010 and 2017, adults aged 50-64 and ≥65 contributed 27% and 38% of 21, 610 reported IPD cases, respectively. The proportion of PCV13-type IPD declined from 52% to 34% in 50-64 cohort, and 50% to 23% in ≥65 cohort, showing a plateau since 2014 in all three age groups (Figure 1).isppd 50+.png

Conclusions

Adults ≥65 years contributed 38%, and those 50-64 years an incremental 27% of all IPD in Canada over the study period. In 2017, 23% and 34% of IPD in these two cohorts, respectively, was of PCV13-type. These findings support the rationale for intensified PCV13 immunization efforts in both age groups.

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NUMBER OF CHILDREN WITHOUT 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) SERIES COMPLETION AT 2 YEARS OF AGE IN CANADA (ID 591)

Abstract

Background

Despite more than 6 years of routine pediatric PCV13 implementation in Canada, PCV13 serotypes still contributed to roughly 25% of invasive pneumococcal disease in older adults in 2017. One of the elements that can affect disease transmission and immunization program effectiveness is vaccine schedule completion. With transition to PCV13 in 2010/2011, a reduced, 2+1 routine immunization schedule was adopted across Canadian provinces, with the third dose recommended at 12 months of age.

Methods

We estimated the cumulative number of children with incomplete routine PCV13 vaccination series from 2011 to 2017, measured at 2 years of age. National Immunization Survey Coverage rates (available for 2011, 2013, 2015 and 2017; averaged for 2012, 2014 and 2016) along with Canadian census data were used to derive the number of children with incomplete PCV13 series.

Results

There were ~609,000 children with incomplete PCV13 series at 2 years of age in Canada in 2011-2017 (Table 1).isppd vaccine coverage.png

Conclusions

The substantial estimated number of children with incomplete PCV13 series by 2 years of age over the study period, coupled with reduced-dose schedule may have undermined achievement of optimal public health impact. Potential role of these factors in PCV13 program effectiveness in Canada requires better understanding.

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COVERAGE OF NEXT GENERATION PNEUMOCOCCAL CONJUGATE VACCINES FOR INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN OF HIGH-INCOME COUNTRIES (ID 608)

Abstract

Background

The serotype distribution of invasive pneumococcal disease (IPD) informs the coverage of next generation pneumococcal conjugate vaccines (PCVs). This analysis describes IPD coverage by the current PCVs (PCV10/PCV13) and next generation, PCV15 and PCV20.

Methods

Serotype counts for children <5 years were obtained from national or regionally-representative IPD surveillance systems from high-income countries. Up to the three most recent years of data were included. Excluded countries reported <20 cases overall or only reported data prior to pediatric PCV introduction into the National Immunization Program (NIP). Coverage was calculated for PCV10 (1,4,5,6B,7F,9V,14,18C,19F,23F), PCV13 (PCV10-types, 3,6A,19A, plus 6C, which is highly-related to 6A), PCV15 (PCV13-types, 22F,33F), and PCV20 (PCV15-types, 8,10A,11A,12F,15B, plus 15C, which is highly-related to 15B) as the number of cases in PCVs divided by the total number of cases (excluding missing and non-typeable cases) reported for each country.

Results

Twenty-seven of 80 (34%) high-income countries met inclusion criteria, reporting >5,000 cases that were included in the analysis. Coverage by current and next generation PCVs varied by country and World Health Organization (WHO) region (Table).

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Conclusions

PCV20 offers substantial coverage above current PCVs and next generation PCV15 and could address the considerable remaining IPD burden among children in high-income countries globally.

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COVERAGE OF NEXT GENERATION PNEUMOCOCCAL CONJUGATE VACCINES FOR INVASIVE PNEUMOCOCCAL DISEASE IN OLDER ADULTS OF HIGH-INCOME COUNTRIES (ID 612)

Abstract

Background

Despite the indirect effects of routine pediatric pneumococcal conjugate vaccine (PCV) use, invasive pneumococcal disease (IPD) persists in older adults. This analysis describes IPD coverage of current PCVs (PCV10/PCV13) and next generation, PCV15 and PCV20.

Methods

Serotype counts for adults ≥60/≥65 years were obtained from national or regionally-representative IPD surveillance systems in high-income countries. Up to the three most recent years of data were included. Excluded countries reported <20 cases overall or only reported data prior to pediatric PCV introduction into the National Immunization Program (NIP). Coverage was calculated for PCV10 (1,4,5,6B,7F,9V,14,18C,19F,23F), PCV13 (PCV10-types,3,6A,19A, plus 6C, which is highly-related to 6A), PCV15 (PCV13-types, 22F,33F), and PCV20 (PCV13-types, 8,10A,11A,12F,15B, plus 15C, which is highly-related to 15B) as the number of cases in PCVs divided by total number of cases (excluding missing and non-typeable) reported for each country.

Results

Twenty-eight of 80 (35%) high-income countries met inclusion criteria, reporting >25,000 cases that were included in the analysis. Coverage by current and next generation PCVs varied by country and World Health Organization (WHO) region (Table).

global ipd st dist_isppd2020 65+ table_2020.1010.jpg

Conclusions

PCV20 offers substantial coverage above current PCVs and next generation PCV15 and could address the considerable remaining IPD burden among older adults in high-income countries globally.

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