Peter McIntyre, Australia

University of Sydney National Centre for Immunisation Research and Surveillance and Kids Research

Author Of 4 Presentations

CHANGES IN PNEUMONIA HOSPITALISATIONS IN AUSTRALIAN INDIGENOUS CHILDREN FOLLOWING PNEUMOCOCCAL VACCINATION (ID 512)

Abstract

Background

Aboriginal and Torres Strait Islander (Indigenous) children in four Australian states/territories were funded from 2001 to receive 3 infant doses of 7-valent pneumococcal conjugate vaccine (7vPCV) followed by 23-valent pneumococcal polysaccharide vaccine in the second year of life. In 2011 all four doses were replaced with 13vPCV. We assessed impact of these vaccination programs on pneumonia hospitalisations in Indigenous children from 1999 to 2017.

Methods

We analysed hospitalisation data for Indigenous children aged <5 years with primary diagnosis of pneumonia and categorised into pneumococcal, unspecified, specified non-pneumococcal and all-cause using ICD-10-AM codes. Age-specific pneumonia hospitalisation rates (per 100,000) were calculated by year and rate changes by vaccine period.

Results

table 1.jpgOver the study duration from pre-7vPCV introduction (1999-2002) to post-13vPCV change (2014-2017) the hospitalisation rate declined by 53% (2811 to 1324/100,000) for all-cause, 85% (133 to 20/100,000) for pneumococcal and 66% (2449 to 842/100,000) for unspecified pneumonia, with the greatest declines in infants <12 months (Table 1). Between 2013-2017 all-cause pneumonia hospitalisations increased in children 12-23 months (1663 to 2859/100,000) and 2-4 years (569 to 828/100,000), largely driven by increasing specified non-pneumococcal pneumonia.

Conclusions

Large declines in pneumonia hospitalisations following 4-dose pneumococcal vaccination in Australian Indigenous children add to reductions in invasive disease previously documented.

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SUBSTANTIAL INDIRECT PROTECTION AGAINST IPD AND PNEUMONIA HOSPITALISATIONS AT LOW LEVELS OF VACCINE COVERAGE IN AUSTRALIA, YET HIGH COVERAGE REQUIRED FOR NEAR-ELIMINATION (ID 854)

INTERCHANGEABILITY OF PHID-CV10 AND PCV13 IN PRIMARY COURSE SCHEDULES (ID 204)

Abstract

Background

In remote communities of northern Australia, we previously demonstrated that the onset of otitis media (OM) in Aboriginal infants was preceded by acquisition of bacterial pathogens that colonise the nasopharynx (NP) soon after birth. We aimed to determine safety and effectiveness of mixed vaccine schedules against early infection due to non-typeable Haemophilus influenzae and Streptococcus pneumoniae.

Methods

In an open-label controlled trial, we randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to either Prevenar13™ (P, PCV13) at 2-4-6 months of age (_PPP), Synflorix™ (S, PHiD-CV10) at 2-4-6 months (_SSS), or Synflorix at 1-2-4 months plus Prevenar13 at 6 months (SSSP). Primary outcomes (assessor-blinded) were immunogenicity at 7 months of age against pneumococcal serotypes 3, 6A, and 19A, and protein D (GMCs and proportions of infants with IgG > 0·35 µg/mL or > 100 EL.U/mL, respectively). Secondary immunogenicity outcomes at 2 and 4 months are also reported.

Results

A 4-dose early 1-2-4-6 month combination schedule of Synflorix plus Prevenar13 (SSSP) provided superior overall immune protection against serotypes 3, 6A, 19A, and protein D, compared to standard 3-dose 2-4-6 month schedules (_SSS or _PPP).

Conclusions

These vaccines can be combined safely and effectively within this primary schedule, with no evidence of immune suppression.

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HEAD TO HEAD COMPARISONS AT 2, 4, AND 7 MONTHS, FOLLOWING STANDARD AND COMBINED PHID-CV10 AND PCV13 SCHEDULES. (ID 429)

Abstract

Background

Australian Aboriginal children are at high risk of early infection withStreptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi). We evaluated immunogenicity against 10 shared serotypes of a 4-dose combination schedule of PHiD-CV10 at 1-2-4 months plus PCV13 at 6 months, compared with standard 2-4-6 month schedules.

Methods

Infants were allocated (1:1:1) at 28 to 38 days of age, to 3-dose schedules of PCV13 (P) or PHiD-CV10 (S) at 2-4-6 months (_PPP or _SSS), or a combination schedule at 1-2-4-6 months (SSSP). Immunogenicity was measured at 2, 4, and 7 months.

Results

At 2 months the SSSP combination was superior to pre-vaccination (VTs other than 6B, 19F, or 23F). At 4 months SSSP was superior to _PPP (9 VTs) and _SSS (7 VTs), and _SSS was superior to _PPP (8 VTs). At 7 months, SSSP was superior to _PPP (1, 6B, 9V, 19F and 23F) and _SSS (8 VTs), and _PPP was superior to _SSS (8 VTs). OPA supports the SSSP schedule, particularly against 1, 6B, and 23F.

Conclusions

The 1-2-4-6 month schedule (SSSP) was superior at 2, 4, and 7 months of age compared to _SSS or _PPP, particularly for 1, 6B, and 23F at 7 months. At 4 months, _SSS was superior to _PPP.

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