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Evidence summaries

Pneumococcal Conjugate Vaccines for Preventing Invasive Pneumococcal Disease and Pneumonia in Children Under Two Years of Age

Pneumococcal conjugate vaccines are effective in reducing the incidence of invasive pneumococcal disease and x-ray confirmed pneumonia in children under two years of age. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 11 publications from 6 studies on the pneumococcal conjugate vaccines (PCV) in prevention of invasive pneumococcal disease (IPD) and pneumonia in children under two years of age, with a total of 113 044 subjects. The vaccines used were 7-valent, 9-valent, and 11-valent pneumococcal conjugate vaccine, and as control, either placebo, hepatitis B or meningococcus type C vaccine were given.

Results from pooling HIV-1 negative children from the South African study with the other studies in United States, Philippines, and Finland were as follows: the pooled vaccine efficacy (VE) for vaccine-type IPD was 80% (95% CI 58% to 90%); all-serotype IPD, 58% (95% CI 29% to 75%); for x-ray confirmed pneumonia was 27% (95% CI 15% to 36%); and all-cause mortality, 11% (95% CI -1% to 21%, P = 0.08). Analysis involving HIV-1 positive children had similar findings.

In another cluster-randomised, double-blind trial 2, 47 369 children aged younger than 19 months received 10-valent PCV in 52 clusters or hepatitis vaccine as control in 26 clusters. Infants aged younger than 7 months at the first vaccination received either a 3 + 1 or a 2 + 1 vaccination schedule, children aged 7 - 11 months received a 2 + 1 schedule, and those 12 -18 months of age received a two-dose schedule. 13 culture-confirmed vaccine-type cases of invasive pneumococcal disease were detected: none in the PCV 3 + 1 group, one in the PCV 2 + 1 group, and 12 in the control groups. The estimates for vaccine effectiveness were 100% (95% CI 83 - 100) for PCV 3 + 1 and 92% (58 - 100) for PCV 2 + 1 groups. Two cases of any culture-confirmed invasive disease irrespective of serotype were detected in combined PCV infant cohorts compared with 14 in the corresponding control cohorts (vaccine effectiveness 93%, 75 - 99). In catch-up cohorts, seven cases of invasive disease were reported, all in the control group: two cases in the children enrolled at 7 - 11 months of age; and five cases in children enrolled at 12 - 18 months of age (vaccine effectiveness 100%, 79 - 100). Non-fatal serious adverse events suspected to be vaccine-related were reported via routine post-immunisation safety surveillance in 18 children.

    References

    • Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreño RA, Nohynek H, Riley ID, Makela H. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev 2009;(4):CD004977. [PubMed].
    • Palmu AA, Jokinen J, Borys D et al. Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial. Lancet 2013;381(9862):214-22. [PubMed]

Primary/Secondary Keywords