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SYSTEMATIC REVIEW OF PNEUMOCOCCAL CONJUGATE VACCINE DOSING SCHEDULES ON CLINICAL OUTCOMES AMONG YOUNG CHILDREN
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| Speaker: |
Laura Conklin
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| Author: |
L. Conklin1, J. Loo1, K. Fleming-Dutra1,2, J. Kirk3, M. Deloria-Knoll4, D. Park4, S. Chandir4, S. Johnson4, D. Goldblatt5, K.L. O'Brien4, C. Whitney1
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| Affiliation: |
1Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, 2Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, 3Westat, Inc., Rockville, 4International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5Immunobiology Unit, UCL Institute of Child Health, London, UK
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Background and aims: Pneumococcal conjugate vaccines (PCV) are rapidly being introduced into national immunization programs. To aid decision-making regarding the optimal dosing schedule, we summarized the effect of PCV schedule on clinical outcomes.
Methods: A systematic review of English literature published from 1994-2011 was conducted on the effects of PCV dosing schedules on vaccine-type (VT) nasopharyngeal carriage, VT invasive pneumococcal disease (IPD), and syndromic pneumonia among young children.
Results: Of 10,205 citations reviewed, we identified 26 carriage, 48 IPD, and 45 pneumonia analyzable studies. Of these, 84 evaluated 3 primary doses plus a booster (“3+1”), 27 “3+0”, 15 “2+1”, and 4 “2+0”; 90% described PCV7. Eleven studies directly compared schedules: 7 showed no significant differences; one described more 6B IPD cases with 2 primary doses compared to 3 in a “3+1”population; one carriage controlled trial showed greater reduction with “2+1” than “2+0”; and 2 (1 carriage controlled trial and 1 syndromic pneumonia case-control study) described greater short-term benefit of 3 primary doses compared to 2. Discerning quantitative differences between schedules was difficult when comparing across studies; programs using “3+1”, “3+0”, and “2+1” all showed significant reductions in IPD and pneumonia, although most programs also used catch-up campaigns.
Conclusions: The available literature demonstrates benefits for 3+1, 3+0, and 2+1 schedules. While some differences in effect were identified between schedules, these may not be significant in settings of a mature program with herd effects or when introduced with a catch-up campaign. More data are needed on these schedules using PCV10 and PCV13.
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