1470 - Epidemiology of Invasive Pneumococcal Disease (IPD) Following 18 years of Pneumococcal Conjugate Vaccine (PCV) Use in the United States

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Presenting Author(s)

TP

Tamara Pilishvili

Epidemiologist
Centers for Disease Control and Prevention, Atlanta, GA, USA
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

RG

Ryan Gierke

Epidemiologist
Centers of Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MF

Monica M. Farley

Division Director/Professor of Medicine
Emory University School of Medicine, Division of Infectious Diseases
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WS

William Schaffner

Professor
Vanderbilt University Medical Center
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AT

Ann Thomas

Public Health Physician
Oregon Health Authority
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AR

Art Reingold

Professor and Division Head, Epidemiology
University of California, Berkeley
Berkeley, CA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LH

Lee Harrison

Professor of Medicine and Epidemiology
University of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure: GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)
CH

Corinne Holtzman

Epidemiologist Senior
Minnesota Department of Health
St. Paul, Minnesota
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KB

Kari Burzlaff

Emerging Infections Program Surveillance Officer
New York State Department of Health
Buffalo, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SP

Susan Petit

Epidemiologist
Connecticut Department of Public Health
Hartford, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RH

Rachel Herlihy

State Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ST

Salina Torres

Active Bacterial Core Surveillance Project Coordinator
New Mexico Department of Health
Santa Fe, New Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BB

Bernard Beall

Director, Streptococcus Laboratory
Centers for Disease Control and Prevention/Retired
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: PCVs have been recommended for U.S. children since 2000. A 7-valent vaccine (PCV7) was introduced in 2000. This was replaced by a 13-valent vaccine (PCV13) in 2010. PCV13 was also recommended for adults aged ≥ 65 years in August 2014. We evaluated PCV impact on IPD.

Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified through CDC’s Active Bacterial Core surveillance during 1998-2018. Isolates were serotyped by Quellung or whole genome sequencing and classified as PCV13-type and non-vaccine-type (NVT). Incidence rates (cases/100,000) were calculated using U.S. Census Bureau population denominators.

Results: From 1998 through 2018, overall IPD rates among children aged < 5 years decreased by 93% (from 95 to 7 cases/100,000). PCV13-type IPD decreased by 98% (from 88 to 2 cases/100,000). Among adults aged ≥ 65 years, overall IPD rates decreased by 60% (from 61 to 25 cases/100,000). PCV13-type IPD rates declined 86% (from 46 to 7 cases/100,000). Declines were most dramatic in the years following PCV7 introduction, with additional declines after PCV13 introduction in children (Figures 1 and 2). Serotypes 3, 19A, and 19F caused most of the remaining PCV13-type IPD. NVT IPD rates did not change significantly among children. Among adults aged 50-64 years, NVT IPD increased by 83% (from 6 to 12 cases/100,000) (p< 0.01). Among adults aged ≥ 65 years, NVT IPD increased by 22% (from 15 to 18 cases/100,000) (p< 0.01). The most common NVTs in 2018 were 22F (10% of all IPD), 9N (7%) and 15A (5%). Among children, the proportion of cases with meningitis increased from 5% to 14% (p< 0.01), and the proportion with pneumonia/empyema increased from 17% to 31% (p< 0.01). Among adults, the proportion of cases with meningitis did not change (3%), while the proportion with pneumonia/empyema increased from 72% to 76% (p=0.01).Figure 1: Incidence of invasive pneumococcal disease among children aged < 5 years, 1998-2018

Figure 2: Incidence of invasive pneumococcal disease among adults aged ≥ 65 years, 1998-2018

Conclusion: Overall IPD incidence among children and adults decreased following PCV introduction for children, driven primarily by reductions in PCV-type IPD. NVT IPD increased in older adults, but these increases did not eliminate reductions from PCV13-type IPD.