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O084 - IMPACT OF PNEUMOCOCCAL CONJUGATE VACCINES (PCV) AND THE COVID-19 PANDEMIC ON INVASIVE PNEUMOCOCCAL DISEASE (IPD) AMONG NATIVE AMERICANS LIVING ON THE NAVAJO NATION (ID 116)
Abstract
Background
Native Americans living on reservations experience high rates of IPD. A 7-valent PCV was introduced in 2000 for children <5 years. In 2010, a 13-valent PCV replaced PCV7 in the US. In late 2014, PCV13 was recommended for adults ≥65 years; this recommendation was revised in 2019, to recommend shared clinical decision-making. COVID-19 and associated mitigation strategies affected the spread of other respiratory diseases.
Methods
We conducted active, laboratory-based surveillance for IPD in Native Americans living on or around the Navajo Nation from 1995-2021. Isolates were serotyped by Quellung reaction. We compared incidence before and after PCV13 introduction and emergence of COVID-19 using incidence rate ratios and binomial exact confidence intervals.
Results
Comparing the PCV7 and PCV13-eras, PCV13-type IPD incidence decreased 93% in children and 48% in adults (Table). Among adults ≥65 years, PCV13-type IPD incidence was unchanged after the adult recommendation (22.7/100,000 in 2011-2014 vs 29.3/100,000 in 2015-2019). Serotypes 3, 8, 12F, and 20 were the leading causes of IPD in the PCV13-era. Comparing the pre-PCV and PCV13-eras, overall incidence declined 85% in children and 25% in adults (Table). In 2020-2021 (COVID-19 era), overall incidence declined 91% in children and 44% in adults, compared to the PCV13-era (Table).
Conclusions
Use of PCVs resulted in a significant and sustained reduction in IPD on the Navajo Nation; however, the remaining burden is substantially higher than in the general U.S. Higher valency vaccines and risk reduction strategies could help address this disparity. The COVID-19 pandemic was associated with an unprecedented and dramatic decline in IPD.