Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: The PSERENADE project - 05/03/25

Doi : 10.1016/j.jinf.2025.106426

Yangyupei Yang ^a,^⁎,^{^{1
Co-first authors.}} , Maria Deloria Knoll ^a,^⁎,^{^{1
Co-first authors.}} , Carly Herbert ^b, Julia C. Bennett ^a, Daniel R. Feikin ^c, Maria Garcia Quesada ^a, Marissa K. Hetrich ^a, Scott L. Zeger ^a, Eunice W. Kagucia ^d, Melody Xiao ^a, Adam L. Cohen ^e,^{^{2
Present address: Centers for Disease Control and Prevention, Atlanta, GA, USA. Affiliation at the time this work was completed was World Health Organization.}}, Mark van der Linden ^f, Mignon du Plessis ^g,^h, Inci Yildirim ⁱ, Brita A. Winje ^j, Emmanuelle Varon ^k, Maria Teresa Valenzuela ^l, Palle Valentiner-Branth ^m, Anneke Steens ⁿ, J. Anthony Scott ^d, Larisa Savrasova ^o,^p, Juan Carlos Sanz ^q, Aalisha Sahu Khan ^r, Kazunori Oishi ^s, Néhémie Nzoyikorera ^t,^u,^v, J. Pekka Nuorti ^w,^x, Jolita Mereckiene ^y, Kimberley McMahon ^z, Allison McGeer ^aa, Grant A. Mackenzie ^ab,^ac,^ad,^ae, Laura MacDonald ^af, Shamez N. Ladhani ^ag, Karl G. Kristinsson ^ah, Jackie Kleynhans ^g,^ai, James D. Kellner ^aj, Sanjay Jayasinghe ^ak, Pak-Leung Ho ^al, Markus Hilty ^am, Laura L. Hammitt ^a,^d, Marcela Guevara ^an,^ao, Charlotte Gilkison ^ap, Ryan Gierke ^aq, Stefanie Desmet ^ar,^as, Philippe De Wals ^at, Ron Dagan ^au, Edoardo Colzani ^av, Pilar Ciruela ^an,^aw, Urtnasan Chuluunbat ^ax, Guanhao Chan ^ay, Romina Camilli ^az, Michael G. Bruce ^ba, Maria-Cristina C. Brandileone ^bb, Krow Ampofo ^bc, Katherine L. O’Brien ^a,^{^{3
Present address: Department of Immunizations, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland. Affiliation at the time this work was completed was Johns Hopkins Bloomberg School of Public Health.}}, Kyla Hayford ^a,^{^{4
Present address: Pfizer, Inc. Collegeville, PA, USA. Affiliation at the time this work was completed was Johns Hopkins Bloomberg School of Public Health.}}
The PSERENADE Team^⁵
Members are listed in Appendix Table A1.
^a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
^b UMass Chan Medical School, Worcester, MA 01655, United States
^c Independent Consultant, 1296 Coppet, Switzerland
^d Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, P.O. Box 230-80108, Kilifi, Kenya
^e World Health Organization, 1202 Geneva, Switzerland
^f Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, 52074 Aachen, Germany
^g Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, 2192 Johannesburg, South Africa
^h School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, 2000 Johannesburg, South Africa
ⁱ Department of Pediatrics, Yale New Haven Children’s Hospital, New Haven, CT 06504, United States
^j Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
^k National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
^l Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de los Andes, Metropolitan Region, Las Condes, Santiago, Chile
^m Infectious Disease Epidemiology and Prevention, Statens Serum Institut, DK-2300 Copenhagen, Denmark
ⁿ Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, the Netherlands
^o Centre for Disease Prevention and Control of Latvia, Riga 1005, Latvia
^p Doctoral Studies Department, Riga Stradiņš University, Riga 1007, Latvia
^q Laboratorio Regional de Salud Pública, Dirección General de Salud Pública, Comunidad de Madrid, 28055 Madrid, Spain
^r Ministry of Health and Medical Services, Suva, Fiji
^s Toyama Institute of Health, Imizu, 939-0363 Toyama, Japan
^t Higher Institute of Bioscience and Biotechnology, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
^u Laboratory of Infectiology and Microbial Biotechnology Research, Mohammed VI Center for Research & Innovation (CM6), Rabat, Morocco
^v National Reference Laboratory, Institut National de Santé Publique (INSP) du Burundi, Bujumbura, Burundi
^w Department of Health Security, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
^x Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland
^y Health Protection Surveillance Centre (HPSC), 25-27 Gardiner Street Middle, Dublin D01 A4A3, Ireland
^z Centre for Disease Control, Department of Health and Community Services, Darwin City, NT 8000, Australia
^aa Toronto Invasive Bacterial Diseases Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
^ab Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia
^ac Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
^ad Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, PO Box 273, Banjul, Gambia
^ae New Vaccines Group, Murdoch Children’s Research Institute, Parkville, Melbourne, 3052 Victoria, Australia
^af Public Health Scotland, Glasgow, United Kingdom
^ag Immunisation and Countermeasures Division, UK Health Security Agency, NW9 5EQ London, United Kingdom
^ah Department of Clinical Microbiology, Landspitali - The National University Hospital, Hringbraut, 101 Reykjavik, Iceland
^ai School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
^aj Department of Pediatrics, University of Calgary, and Alberta Health Services, Calgary, Alberta T3B 6A8, Canada
^ak National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, 2145 NSW, Australia
^al Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR
^am Swiss National Reference Centre for invasive Pneumococci, Institute for Infectious Diseases, University of Bern, 3012 Bern, Switzerland
^an CIBER Epidemiología y Salud Pública, (CIBERESP), 28029 Madrid, Spain
^ao Instituto de Salud Pública de Navarra – IdiSNA, 31003 Pamplona, Navarra, Spain
^ap Epidemiology Team, Institute of Environmental Science and Research, Porirua, 5022 Wellington, New Zealand
^aq Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
^ar Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
^as National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, 3000 Leuven, Belgium
^at Department of Social and Preventive Medicine, Laval University, Québec, Quebec G1V 0A6, Canada
^au The Shraga Segal Dept. of Microbiology, Immunology and Genetics Faculty of Health Sciences of the Ben-Gurion University of the Negev, Beer-Sheva, Israel
^av European Centre for Disease Prevention and Control, 169 73 Solna, Sweden
^aw Surveillance and Public Health Emergency Response, Public Health Agency of Catalonia, 08005 Barcelona, Spain
^ax National Center of Communicable Diseases (NCCD), Ministry of Health, Bayanzurkh District, 13336 Ulaanbaatar, Mongolia
^ay Singapore Ministry of Health, Communicable Diseases Division, 308442, Singapore
^az Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
^ba Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, United States
^bb National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, 01246-902, Brazil
^bc Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT 84132, United States

^⁎Corresponding authors.

Summary

Background

Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally.

Methods

The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally. Site-specific meningitis incidence rate ratios (IRRs) comparing pre-PCV incidence to each year post-PCV10/13 were estimated by age (<5, 5–17 and ≥18 years) using Bayesian multi-level mixed effects Poisson regression, accounting for pre-PCV trends. All-site weighted average IRRs were estimated using linear mixed-effects regression stratified by age, product (PCV10 or PCV13) and prior PCV7 impact (none, moderate, or substantial). Changes in pneumococcal meningitis incidence were estimated overall and for product-specific vaccine-types and non-PCV13-types.

Results

Analyses included 10,168 cases <5 y from PCV13 sites and 2849 from PCV10 sites, 3711 and 1549 for 5–17 y and 29,187 and 5653 for ≥18 y from 42 surveillance sites (30 PCV13, 12 PCV10, 2 PCV10/13) in 30 countries, primarily high-income (84%). Six years after PCV10/PCV13 introduction, pneumococcal meningitis declined 48–74% across products and PCV7 impact strata for children <5 y, 35–62% for 5–17 y and 0–36% for ≥18 y. Impact against PCV10-types at PCV10 sites, and PCV13-types at PCV13 sites was high for all age groups (<5 y: 96–100%; 5–17 y: 77–85%; ≥18 y: 73–85%). After switching from PCV7 to PCV10/13, increases in non-PCV13-types were generally low to none for all age groups.

Conclusion

Pneumococcal meningitis declined in all age groups following PCV10/PCV13 introduction. Plateaus in non-PCV13-type meningitis suggest less replacement than for all IPD. Data from meningitis belt and high-burden settings were limited.

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Highlights

•	PCV10 & PCV13 reduced pneumococcal meningitis 48-74% globally in children under 5.
•	Indirect protection from PCV10 & PCV13 reduced pneumococcal meningitis in all ages.
•	Replacement disease due to non-vaccine-type serotypes was minimal.
•	Settings with serotype 19A meningitis likely benefit from PCVs targeting 19A.
•	Increases in non-PCV13-type meningitis plateaued unlike for all invasive disease.

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Keywords : Pneumococcal meningitis, Pneumococcal conjugate vaccines, Serotypes, Vaccine impact, Incidence, Serotype replacement, Indirect protection

Plan

Introduction

Methods

Data collection and eligibility criteria

Adjustments for missing data

Statistical analyses

Results

Impact among children <5 years of age

Impact among children 5-17 years of age

Impact among adults ≥18 years of age

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Vol 90 - N° 3

Article 106426- mars 2025 Retour au numéro

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Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: The PSERENADE project - 05/03/25

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