1

Agir au mieux pour preacutevenir les

infections pneumococciques

Tour drsquohorizon agrave travers le Monde

et Perspectives

ACPP- Infovac-Maroc

Pr Robert COHEN

2

Fardeau des infections pneumococciques chez

les enfants Seacuteveacuteriteacute de la maladie

Inva

sive

N

on

inva

sive

Preacutevalence Pour chaque cas de

meacuteningite il yrsquoa

approximativement Meacuteningites

Bacteacuterieacutemies

Pneumonies

Otites moyennes aiguecircs gtX 2000

X 200

X 20

Adapted from Pneumococcal Disease CDC Website httpwwwcdcgovvaccinespubspinkbookdownloadspneumopdf Accessed April 11 2011

Note Based on surveillance before the Introduction of PCV

2

Fardeau des infections pneumococciques chez

les enfants Seacuteveacuteriteacute de la maladie

Inva

sive

N

on

inva

sive

Preacutevalence Pour chaque cas de

meacuteningite il yrsquoa

approximativement Meacuteningites

Bacteacuterieacutemies

Pneumonies

Otites moyennes aiguecircs gtX 2000

X 200

X 20

Adapted from Pneumococcal Disease CDC Website httpwwwcdcgovvaccinespubspinkbookdownloadspneumopdf Accessed April 11 2011

Note Based on surveillance before the Introduction of PCV

3

La niche eacutecologique du pneumocoque

Le microbiome rhino-pharyngeacute

3

4

Incidence des IIP USA (1997 agrave 2011)

Active Bacterial Core Surveillance CDC Website httpwwwcdcgovabcsreports-findingssurv-reportshtml Updated January 28 2014 Accessed April 15 2014

Enfants de 1 agrave 2 ans

0

50

100

150

200

250 Pre-PCV7

Introduction

PCV7

Introduction

Post-PCV7

Introduction PCV13

Introduction

2000 2010

PCV7 PCV13

5

Preacutevention du nombre de cas drsquoIIP et de deacutecegraves dus agrave la maladie

pneumococcique invasive apregraves introduction du PCV7 et PCV13 chez les

enfants lt et ge 5 ans aux USA

5

Moore M et al Lancet 2015

Aux USA

En 2000 -gt PCV7

En 2010 -gt PCV13

3 ans apregraves lrsquointroduction du PCV13

Preacutevention de ~30 000 cas drsquoIIP

Preacutevention de ~3000 deacutecegraves

De 2001 agrave 2012 PCV7 suivi de PCV13

Preacutevention de ~ 400 000 cas drsquoIIP

Preacutevention de ~ 30 000 deacutecegraves

2000 2010

PCV7 PCV13

6

Angleterre et Pays de Galle Incidence des IIP

2000-2014

Waight PA Andrews NJ Ladhani SN et al Lancet Infect Dis 2015 Published Online March 20 2015 httpdxdoiorg101016 S1473-

3099(15)70044-7

7

Taux de visites pour OMA par enfant anneacutee chez des enfants de

le 6 ans chez des enfants lt 2 ans aux USA

Tal Marom et al JAMA Pediatr 2014 168(1)68-75

2000 2010

PCV7 PCV13

Enfants le 6 ans Enfants lt 2 ans

8

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

4

Incidence des IIP USA (1997 agrave 2011)

Active Bacterial Core Surveillance CDC Website httpwwwcdcgovabcsreports-findingssurv-reportshtml Updated January 28 2014 Accessed April 15 2014

Enfants de 1 agrave 2 ans

0

50

100

150

200

250 Pre-PCV7

Introduction

PCV7

Introduction

Post-PCV7

Introduction PCV13

Introduction

2000 2010

PCV7 PCV13

5

Preacutevention du nombre de cas drsquoIIP et de deacutecegraves dus agrave la maladie

pneumococcique invasive apregraves introduction du PCV7 et PCV13 chez les

enfants lt et ge 5 ans aux USA

5

Moore M et al Lancet 2015

Aux USA

En 2000 -gt PCV7

En 2010 -gt PCV13

3 ans apregraves lrsquointroduction du PCV13

Preacutevention de ~30 000 cas drsquoIIP

Preacutevention de ~3000 deacutecegraves

De 2001 agrave 2012 PCV7 suivi de PCV13

Preacutevention de ~ 400 000 cas drsquoIIP

Preacutevention de ~ 30 000 deacutecegraves

2000 2010

PCV7 PCV13

6

Angleterre et Pays de Galle Incidence des IIP

2000-2014

Waight PA Andrews NJ Ladhani SN et al Lancet Infect Dis 2015 Published Online March 20 2015 httpdxdoiorg101016 S1473-

3099(15)70044-7

7

Taux de visites pour OMA par enfant anneacutee chez des enfants de

le 6 ans chez des enfants lt 2 ans aux USA

Tal Marom et al JAMA Pediatr 2014 168(1)68-75

2000 2010

PCV7 PCV13

Enfants le 6 ans Enfants lt 2 ans

8

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

5

Preacutevention du nombre de cas drsquoIIP et de deacutecegraves dus agrave la maladie

pneumococcique invasive apregraves introduction du PCV7 et PCV13 chez les

enfants lt et ge 5 ans aux USA

5

Moore M et al Lancet 2015

Aux USA

En 2000 -gt PCV7

En 2010 -gt PCV13

3 ans apregraves lrsquointroduction du PCV13

Preacutevention de ~30 000 cas drsquoIIP

Preacutevention de ~3000 deacutecegraves

De 2001 agrave 2012 PCV7 suivi de PCV13

Preacutevention de ~ 400 000 cas drsquoIIP

Preacutevention de ~ 30 000 deacutecegraves

2000 2010

PCV7 PCV13

6

Angleterre et Pays de Galle Incidence des IIP

2000-2014

Waight PA Andrews NJ Ladhani SN et al Lancet Infect Dis 2015 Published Online March 20 2015 httpdxdoiorg101016 S1473-

3099(15)70044-7

7

Taux de visites pour OMA par enfant anneacutee chez des enfants de

le 6 ans chez des enfants lt 2 ans aux USA

Tal Marom et al JAMA Pediatr 2014 168(1)68-75

2000 2010

PCV7 PCV13

Enfants le 6 ans Enfants lt 2 ans

8

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

6

Angleterre et Pays de Galle Incidence des IIP

2000-2014

Waight PA Andrews NJ Ladhani SN et al Lancet Infect Dis 2015 Published Online March 20 2015 httpdxdoiorg101016 S1473-

3099(15)70044-7

7

Taux de visites pour OMA par enfant anneacutee chez des enfants de

le 6 ans chez des enfants lt 2 ans aux USA

Tal Marom et al JAMA Pediatr 2014 168(1)68-75

2000 2010

PCV7 PCV13

Enfants le 6 ans Enfants lt 2 ans

8

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

7

Taux de visites pour OMA par enfant anneacutee chez des enfants de

le 6 ans chez des enfants lt 2 ans aux USA

Tal Marom et al JAMA Pediatr 2014 168(1)68-75

2000 2010

PCV7 PCV13

Enfants le 6 ans Enfants lt 2 ans

8

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

8

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

9

0

2

4

6

8

10

12

14

16

18

20

1(n=663) 2(n=573) 3(n=658) 4(n=622) 5(n=750) 6(n=645) 7(n=530) 8(n=600) 9(n=601) 10(n=598) 11(n=582) 12(n=591) 13(n=578) 14(n=582)

ST19A Lineacuteaire(ST19A)

Trend test from year

1 to 9

Trend test from year

10 to 14

PCV13

implementation

plt0001

plt0001

Serotype 19A AOM feverplusmn otalgia 8573 children 14 years

86

29

Study Years (Year 1 Oct 2001June 2002 Year 14 Oct 2014 March 2015)

n=41

n=16

n=7

n=17

Cohen Vaccine 2015 Sep 2233(39)5118-26

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

10

Number of Sp meningitis

Age distribution for IPD Sp meningitis and Sp carriage

Number of IPD

Sp carriage (healthy)

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

le12m 18 m 24 m 30 m 36 m 42 m 48 m 54 m 60 m

10

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

11

Variation of IPD profiles according to serotypes

Levy C et al CID 2015

594 children with IPD recorded after PCV13 implementation from 2011 to 2015

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

12

PCV10 ou PCV13

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

13

Both PCVs are availablereimbursed in the NIP or the NIP consists of different PCVs by region

Programme national dimmunisation avec

le PCV agrave travers le monde1-2

1 Gavi Alliance Progress Report 2013 httpwwwgaviallianceorgresultsgavi-progress-reports 2 Data on file Pfizer

PCV13

PCV13 amp PCV10

PCV10

PCV13 NIP Announced

PCV10 NIP Announced

Mise agrave jour mars 2015

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

14

bull Il srsquoagit de 2 bons vaccins preacutevenant bien les

infections invasives agrave pneumocoques

bull Avantages theacuteoriques du PCV13 sont

ndash 3 valences suppleacutementaires

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

15

bull 3 valences suppleacutementaires

bull 19A

ndash Seacuterotype majeur impliqueacute dans toutes les pathologies

ndash Reacutesistance aux antibiotiques

Le 10 valent exerce probablement un effet protecteur

contre les infections invasives agrave 19 A

bull 3 ndash Seacuterotype important

ndash Activiteacute du PCV13 moins bien deacutemontreacute

bull 6A ndash Protection croiseacutee 6B (PCV7 et PCV10)

ndash 6AProtegravege contre le 6C

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

16

ndash Une meilleure immunogeacuteniciteacute sur la tregraves grande

majoriteacute des seacuterotypes et notamment le 19A

bull Les deux vaccins suscitent des taux drsquoanticorps

protecteurs contre les infections invasives

bull Par contre les taux drsquoanticorps plus eacuteleveacutes du

PCV13 Impact plus grand sur le portage

bull 2 conseacutequences ndash Pas drsquoeffet troupeau du 1O Valent sur le 19A

ndash Echecs de vaccinations vont probablement persister

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

17

PCV10 Impact on Carriage of Serotype 19A

bull Carriage data from PCV10 clinical trials

ndash COMPAS (Panama) Finland Netherlands

bull Only one time point (out of 15 points measured in 3 clinical trials) shows any reduction in 19A carriage

ndash In a 3+1 schedule (not in a 2+1 schedule)

Mrkvan T et al Serotype 19A and PHiD-CV Lessons learned to date Adapted from poster presentation 31st Annual Meeting of the European Society for

Paediatric Infectious Diseases ESPID May 30 2013 Milan Italy

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

18

PCV10 Kilifi Kenya

Nasopharyngeal Carriage

PCV10 demonstrated no effect on NPC prevalence for serotypes 19A or 6A

Difference in NPC prevalence between baseline amp vaccine periods was statistically significant for only serotypes 6B and 19F

Serotype-specific carriage prevalence of Streptococcus pneumoniae among children younger

than 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS) where an

additional catch-up campaign provided up to two doses of PCV10 to children aged 12mdash59 months

p=0middot0003 daggerp=0middot002

Hammitt LL et al Population effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of

Streptococcus pneumoniae and non-typeable Haemophilus influenzae in Kilifi Kenya findings from cross-sectional

carriage studies The Lancet Global Health 28 May 2014 DOI 101016S2214-109X(14)70224-4

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

19

19A IPD cases in New Zealand

PCV10 officially replaced PCV7 on the childhood NIP schedule from July 2011 but PCV7 continued to be used until late 2011

PCV13 officially replaced PCV10 on the childhood NIP schedule from July 2014 but PCV10 continued to be used until late 2014

Source New Zealand Public Health Surveillance institute of Environmental Science and Research Ltd (ESR) Accessed

13Feb2015 from httpssurvesrcrinzsurveillanceIPDphp

20

Serotype 19A IPD Cases By Age Group

US and Finland National Surveillance

1 Moore MR Link-Gelles R Schaffner W et al Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the US

analysis of multisite population-based surveillance Lancet Infect Dis Published online 02Feb 2015 DOI httpdxdoiorg101016S1473-3099(14)71081-3

2 Finland Institute for Health and Welfare (THL) httpwwwthlfienwebthlfi-entopicsinformation-packagesincidence-of-invasive-pneumococcal-disease-in-finland

lt5 y 5ndash17 y 18ndash49 y 50ndash64 y 65+ y

PCV13

Mar 2010

PCV10

Sep 2010

US ndash Serotype 19A IPD1

Finland ndash Serotype 19A IPD2

Case

s

Case

s

21

Prochains vaccins pneumococciques

conjugueacutes

22

PCV20

bull 9N possible protection croiseacutee pour le 9V

bull ^6A protection croiseacutee pour le 6C

bull 15B possible protection croiseacutee pour le 15C

1 2 3 4 5 6A 6B 7F 8 9N 9V 10A 11A 12F 14 15B 17F 18C 19A 19F 20 22F 23F 33F

Prevnar

13 ^

PCV15

^

20v

PnC

^

PPSV23

A 20 valent conjugates composition comprising glycoconjugates from S pneumoniae serotypes 1 3 4 5 6A 6B 7F 8 9V 10A 11A 12F 14

15B 18C 19A 19F 22F 23F and 33F (20vPnC) all individually conjugated to CRMsub197

httpappftusptogovnetacginph-

ParserSect1=PTO1ampSect2=HITOFFampd=PG01ampp=1ampu=2Fnetahtml2FPTO2Fsrchnumhtmlampr=1ampf=Gampl=50amps1=222015020230922PGN

RampOS=DN20150202309ampRS=DN20150202309

22

PCV20

bull 9N possible protection croiseacutee pour le 9V

bull ^6A protection croiseacutee pour le 6C

bull 15B possible protection croiseacutee pour le 15C

1 2 3 4 5 6A 6B 7F 8 9N 9V 10A 11A 12F 14 15B 17F 18C 19A 19F 20 22F 23F 33F

Prevnar

13 ^

PCV15

^

20v

PnC

^

PPSV23

A 20 valent conjugates composition comprising glycoconjugates from S pneumoniae serotypes 1 3 4 5 6A 6B 7F 8 9V 10A 11A 12F 14

15B 18C 19A 19F 22F 23F and 33F (20vPnC) all individually conjugated to CRMsub197

httpappftusptogovnetacginph-

ParserSect1=PTO1ampSect2=HITOFFampd=PG01ampp=1ampu=2Fnetahtml2FPTO2Fsrchnumhtmlampr=1ampf=Gampl=50amps1=222015020230922PGN

RampOS=DN20150202309ampRS=DN20150202309

23

Clinical Burden of Additional 7

Serotypes Contained in PCV20 ST Profile

Serotype 8 Invasive low carriage123

Serotype 10A Invasive moderate carriage12

Serotype 11A Non Invasive high carriage123 multidrug resistant23

Serotype 12F Invasive low carriage234 AOM4

Serotype 15B Non Invasive moderate carriage12 3 multidrug resistant23

Serotype 22F Invasive moderate carriage123

Serotype 33F Invasive low carriage123

IPD invasive pneumococcal disease pneumococcal conjugate vaccine

1 Van Hoek AJ et al PLoS One 20127(7)e39150

2 Varon CNRP 2014

3 Cohen et al Vaccine 2015

4 Azzari PIDJ 2014

24

Back-Up

25

Hi+Sp

associated ST - Among Sp carriers Hi association =48

0

10

20

30

40

50

60

70

80

90

100

7F 3 6A 25A 6B 12F 9N 31 19F 16F 19A 20 29 NT 34 10A 35F 15BC 35B 15F

25

26

Distribution of main serotypes overall IPD by period

26

ST

20082009

N=388 ()

20122013

N=181 ()

P

Evolution of the rank

19A 128 (33) 16 (9) 0000 1 2

7F 53 (14) 0 0000 2

1 30 (8) 0 0000 3

24F 25 (6) 36 (20) 0000 4 1

3 18 (5) 5 (3) 5 10

15BC 17 (4) 15 (8) 0077 6 4

25A 15 (4) 0 0004 7

19F 10 (3) 7 (4) 8 8

12F 9 (2) 16 (9) 0001 9 2

10A 7 (2) 14 (8) 0001 10 5

15A 6 (1) 13 (7) 0002 11 6

22F 6 (1) 9 (5) 0024 11 7

33F 5 (1) 6 (3) 14 9

Varon et al Vaccine 2015

27

Distribution of main serotypes meningitis by period

27

ST

20082009

N=102 ()

20122013

N=64 ()

P

Evolution of the rank

19A 33 (32) 6 (9) 0001 1 3

7F 12 (12) 0 0004 2

24F 11 (11) 17 (27) 0011 3 1

15BC 7 (7) 4 (6) 4 5

10A 5 (5) 6 (9) 5 3

15A 4 (4) 4 (6) 6 5

22F 3 (3) 1 (2) 7 12

25A 3 (3) 0 7

17F 3 (3) 0 7

1 2 (2) 0 10

3 2 (2) 1 (2) 10 12

12F 1 (1) 8 (13) 0002 15 2

19F 1 (1) 3 (5) 15 7

Varon et al Vaccine 2015

28

Distribution of main serotypes pneumonia by period

28

ST

20082009

N=85()

20122013

N=29()

P

Evolution of the rank

19A 28 (33) 5 (17) 1 2

7F 12 (14) 0 0035 2

1 8 (9) 0 3

3 7 (8) 0 4

25A 4 (5) 0 5

19F 4 (5) 1 (4) 5 8

12F 4 (5) 2 (7) 5 5

14 3 (4) 0 8

5 2 (2) 0 9

24F 1 (1) 8 (28) 0000 11 1

15BC 1 (1) 3 (10) 0050 11 3

15A 1 (1) 3 (10) 0050 11 3

33F 0 2 (7) 5

Varon et al Vaccine 2015

24

Back-Up

25

Hi+Sp

associated ST - Among Sp carriers Hi association =48

0

10

20

30

40

50

60

70

80

90

100

7F 3 6A 25A 6B 12F 9N 31 19F 16F 19A 20 29 NT 34 10A 35F 15BC 35B 15F

25

26

Distribution of main serotypes overall IPD by period

26

ST

20082009

N=388 ()

20122013

N=181 ()

P

Evolution of the rank

19A 128 (33) 16 (9) 0000 1 2

7F 53 (14) 0 0000 2

1 30 (8) 0 0000 3

24F 25 (6) 36 (20) 0000 4 1

3 18 (5) 5 (3) 5 10

15BC 17 (4) 15 (8) 0077 6 4

25A 15 (4) 0 0004 7

19F 10 (3) 7 (4) 8 8

12F 9 (2) 16 (9) 0001 9 2

10A 7 (2) 14 (8) 0001 10 5

15A 6 (1) 13 (7) 0002 11 6

22F 6 (1) 9 (5) 0024 11 7

33F 5 (1) 6 (3) 14 9

Varon et al Vaccine 2015

27

Distribution of main serotypes meningitis by period

27

ST

20082009

N=102 ()

20122013

N=64 ()

P

Evolution of the rank

19A 33 (32) 6 (9) 0001 1 3

7F 12 (12) 0 0004 2

24F 11 (11) 17 (27) 0011 3 1

15BC 7 (7) 4 (6) 4 5

10A 5 (5) 6 (9) 5 3

15A 4 (4) 4 (6) 6 5

22F 3 (3) 1 (2) 7 12

25A 3 (3) 0 7

17F 3 (3) 0 7

1 2 (2) 0 10

3 2 (2) 1 (2) 10 12

12F 1 (1) 8 (13) 0002 15 2

19F 1 (1) 3 (5) 15 7

Varon et al Vaccine 2015

28

Distribution of main serotypes pneumonia by period

28

ST

20082009

N=85()

20122013

N=29()

P

Evolution of the rank

19A 28 (33) 5 (17) 1 2

7F 12 (14) 0 0035 2

1 8 (9) 0 3

3 7 (8) 0 4

25A 4 (5) 0 5

19F 4 (5) 1 (4) 5 8

12F 4 (5) 2 (7) 5 5

14 3 (4) 0 8

5 2 (2) 0 9

24F 1 (1) 8 (28) 0000 11 1

15BC 1 (1) 3 (10) 0050 11 3

15A 1 (1) 3 (10) 0050 11 3

33F 0 2 (7) 5

Varon et al Vaccine 2015

25

Hi+Sp

associated ST - Among Sp carriers Hi association =48

0

10

20

30

40

50

60

70

80

90

100

7F 3 6A 25A 6B 12F 9N 31 19F 16F 19A 20 29 NT 34 10A 35F 15BC 35B 15F

25

26

Distribution of main serotypes overall IPD by period

26

ST

20082009

N=388 ()

20122013

N=181 ()

P

Evolution of the rank

19A 128 (33) 16 (9) 0000 1 2

7F 53 (14) 0 0000 2

1 30 (8) 0 0000 3

24F 25 (6) 36 (20) 0000 4 1

3 18 (5) 5 (3) 5 10

15BC 17 (4) 15 (8) 0077 6 4

25A 15 (4) 0 0004 7

19F 10 (3) 7 (4) 8 8

12F 9 (2) 16 (9) 0001 9 2

10A 7 (2) 14 (8) 0001 10 5

15A 6 (1) 13 (7) 0002 11 6

22F 6 (1) 9 (5) 0024 11 7

33F 5 (1) 6 (3) 14 9

Varon et al Vaccine 2015

27

Distribution of main serotypes meningitis by period

27

ST

20082009

N=102 ()

20122013

N=64 ()

P

Evolution of the rank

19A 33 (32) 6 (9) 0001 1 3

7F 12 (12) 0 0004 2

24F 11 (11) 17 (27) 0011 3 1

15BC 7 (7) 4 (6) 4 5

10A 5 (5) 6 (9) 5 3

15A 4 (4) 4 (6) 6 5

22F 3 (3) 1 (2) 7 12

25A 3 (3) 0 7

17F 3 (3) 0 7

1 2 (2) 0 10

3 2 (2) 1 (2) 10 12

12F 1 (1) 8 (13) 0002 15 2

19F 1 (1) 3 (5) 15 7

Varon et al Vaccine 2015

28

Distribution of main serotypes pneumonia by period

28

ST

20082009

N=85()

20122013

N=29()

P

Evolution of the rank

19A 28 (33) 5 (17) 1 2

7F 12 (14) 0 0035 2

1 8 (9) 0 3

3 7 (8) 0 4

25A 4 (5) 0 5

19F 4 (5) 1 (4) 5 8

12F 4 (5) 2 (7) 5 5

14 3 (4) 0 8

5 2 (2) 0 9

24F 1 (1) 8 (28) 0000 11 1

15BC 1 (1) 3 (10) 0050 11 3

15A 1 (1) 3 (10) 0050 11 3

33F 0 2 (7) 5

Varon et al Vaccine 2015

26

Distribution of main serotypes overall IPD by period

26

ST

20082009

N=388 ()

20122013

N=181 ()

P

Evolution of the rank

19A 128 (33) 16 (9) 0000 1 2

7F 53 (14) 0 0000 2

1 30 (8) 0 0000 3

24F 25 (6) 36 (20) 0000 4 1

3 18 (5) 5 (3) 5 10

15BC 17 (4) 15 (8) 0077 6 4

25A 15 (4) 0 0004 7

19F 10 (3) 7 (4) 8 8

12F 9 (2) 16 (9) 0001 9 2

10A 7 (2) 14 (8) 0001 10 5

15A 6 (1) 13 (7) 0002 11 6

22F 6 (1) 9 (5) 0024 11 7

33F 5 (1) 6 (3) 14 9

Varon et al Vaccine 2015

27

Distribution of main serotypes meningitis by period

27

ST

20082009

N=102 ()

20122013

N=64 ()

P

Evolution of the rank

19A 33 (32) 6 (9) 0001 1 3

7F 12 (12) 0 0004 2

24F 11 (11) 17 (27) 0011 3 1

15BC 7 (7) 4 (6) 4 5

10A 5 (5) 6 (9) 5 3

15A 4 (4) 4 (6) 6 5

22F 3 (3) 1 (2) 7 12

25A 3 (3) 0 7

17F 3 (3) 0 7

1 2 (2) 0 10

3 2 (2) 1 (2) 10 12

12F 1 (1) 8 (13) 0002 15 2

19F 1 (1) 3 (5) 15 7

Varon et al Vaccine 2015

28

Distribution of main serotypes pneumonia by period

28

ST

20082009

N=85()

20122013

N=29()

P

Evolution of the rank

19A 28 (33) 5 (17) 1 2

7F 12 (14) 0 0035 2

1 8 (9) 0 3

3 7 (8) 0 4

25A 4 (5) 0 5

19F 4 (5) 1 (4) 5 8

12F 4 (5) 2 (7) 5 5

14 3 (4) 0 8

5 2 (2) 0 9

24F 1 (1) 8 (28) 0000 11 1

15BC 1 (1) 3 (10) 0050 11 3

15A 1 (1) 3 (10) 0050 11 3

33F 0 2 (7) 5

Varon et al Vaccine 2015

27

Distribution of main serotypes meningitis by period

27

ST

20082009

N=102 ()

20122013

N=64 ()

P

Evolution of the rank

19A 33 (32) 6 (9) 0001 1 3

7F 12 (12) 0 0004 2

24F 11 (11) 17 (27) 0011 3 1

15BC 7 (7) 4 (6) 4 5

10A 5 (5) 6 (9) 5 3

15A 4 (4) 4 (6) 6 5

22F 3 (3) 1 (2) 7 12

25A 3 (3) 0 7

17F 3 (3) 0 7

1 2 (2) 0 10

3 2 (2) 1 (2) 10 12

12F 1 (1) 8 (13) 0002 15 2

19F 1 (1) 3 (5) 15 7

Varon et al Vaccine 2015

28

Distribution of main serotypes pneumonia by period

28

ST

20082009

N=85()

20122013

N=29()

P

Evolution of the rank

19A 28 (33) 5 (17) 1 2

7F 12 (14) 0 0035 2

1 8 (9) 0 3

3 7 (8) 0 4

25A 4 (5) 0 5

19F 4 (5) 1 (4) 5 8

12F 4 (5) 2 (7) 5 5

14 3 (4) 0 8

5 2 (2) 0 9

24F 1 (1) 8 (28) 0000 11 1

15BC 1 (1) 3 (10) 0050 11 3

15A 1 (1) 3 (10) 0050 11 3

33F 0 2 (7) 5

Varon et al Vaccine 2015

28

Distribution of main serotypes pneumonia by period

28

ST

20082009

N=85()

20122013

N=29()

P

Evolution of the rank

19A 28 (33) 5 (17) 1 2

7F 12 (14) 0 0035 2

1 8 (9) 0 3

3 7 (8) 0 4

25A 4 (5) 0 5

19F 4 (5) 1 (4) 5 8

12F 4 (5) 2 (7) 5 5

14 3 (4) 0 8

5 2 (2) 0 9

24F 1 (1) 8 (28) 0000 11 1

15BC 1 (1) 3 (10) 0050 11 3

15A 1 (1) 3 (10) 0050 11 3

33F 0 2 (7) 5

Varon et al Vaccine 2015