Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program

• Published in: Vaccine Vol. 34; no. 25; pp. 2766 - 2778
• Main Authors: Moreira, Marta, Cintra, Otavio, Harriague, Julie, Hausdorff, William P., Hoet, Bernard
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 27.05.2016; Elsevier Limited
• Subjects: Acute otitis media; Age; Allergy and Immunology; Brazil; Brazil - epidemiology; Carrier State - microbiology; Child, Preschool; childhood; children; Confidence intervals; developing countries; Ear diseases; Haemophilus influenzae; Health surveillance; Hospitalization; Humans; Immunity, Herd; Immunization; Immunization Programs; Information systems; Invasive pneumococcal disease; Meningitis; Meningitis, Pneumococcal - prevention & control; morbidity; Mortality; Nasopharyngeal carriage; Nasopharynx - microbiology; Observational Studies as Topic; Online data bases; otitis media; Otitis Media - prevention & control; pathogens; Pneumococcal Infections - prevention & control; Pneumococcal Vaccines - therapeutic use; Pneumonia; Pneumonia, Pneumococcal - prevention & control; Population; Population Surveillance; Public health; Randomized Controlled Trials as Topic; Streptococcus infections; Streptococcus pneumoniae; Studies; Vaccines; Brazil; PCV; Pneumonia; NTHi; Nasopharyngeal carriage; NS; CI; Invasive pneumococcal disease; NVT; VE; Streptococcus pneumoniae; CVE; IAL; Acute otitis media; RCTs; SINAN; Brazil; PHiD-CV; IPD; PM; VT; AOM; statistically non-significant; invasive pneumococcal disease; randomized controlled trials; acute otitis media; pneumococcal meningitis; Centro de Vigilância Epidemiológica; pneumococcal conjugate vaccine; vaccine-type; non-vaccine type; non-typeable Haemophilus influenzae; pneumococcal Haemophilus influenzae protein D conjugate vaccine; Instituto Adolfo Lutz; vaccine effectiveness; confidence interval; Notifiable Diseases Information System
• ISSN: 0264-410X; 1873-2518; 1873-2518
• DOI: 10.1016/j.vaccine.2016.04.006

Brazil introduced the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix™, GSK Vaccines) in the routine childhood immunization program in 2010 with a 3+1 schedule (with catch-up for children <2 years-old). This review represents the first analysis of the overall impact of a second-generation pneumococcal conjugate vaccine on nasopharyngeal carriage and all the major pneumococcal disease manifestations in a single, pneumococcal conjugate vaccine-naïve, developing country. A total of 15 published articles and 13 congress abstracts were included in the analysis. In children <5 years-old, studies showed a positive impact of PHiD-CV on the incidence of vaccine-type and any-type invasive pneumococcal disease (including decreases in pneumococcal meningitis morbidity and mortality), on pneumonia incidence and mortality, and on otitis media. Nasopharyngeal carriage of vaccine-type and any-type pneumococci decreased after the primary doses, with no early signs of replacement with other pathogens. Finally, herd protection against vaccine-type invasive pneumococcal disease and pneumonia in unvaccinated subjects was shown in some studies for some age groups. In conclusion, pneumococcal disease decreased after the introduction of PHiD-CV into the Brazilian national immunization program. Further follow-up is needed to evaluate the long-term overall impact of PHiD-CV in the Brazilian population.