I2. Pediatric Vaccines

Oral Abstract Submission

2903 - Post PCV13 Dynamics of Non-Vaccine Serotype (NVT): Disproportionate Increase of the Additional PCV20 Candidate Serotypes in Respiratory and Invasive Disease in Young Children

Presenting Author(s)

• SB

  Shalom Ben-Shimol, MD

  Senior Consultant PID
  Soroka University Med Ctr and Ben-Gurion University
  Beer Sheva, HaDarom, Israel

  Disclosure: Pfizer: Grant/Research Support, Speaker's Bureau

Co-Author(s)

• NG

  Noga Givon-Lavi, PhD

  Epidemiologist
  Soroka Univ Med Ctr and Ben-Gurion Univ
  Beer Sheva, HaDarom, Israel

  Disclosure: Nothing to disclose
• LK

  Leore Kotler, Medical Student 4th year

  Medical Student
  Soroka Univ Med Ctr and Ben-Gurion Univ
  Beer Sheva, HaDarom, Israel

  Disclosure: Nothing to disclose
• DG

  David Greenberg, MD

  Professor of Pediatrics and Infectious Disease
  Soroka Univ Med Ctr and Ben-Gurion Univ
  Beer Sheva, HaDarom, Israel

  Disclosure: Pfizer, MSD: Consultant, Grant/Research Support, Speaker's Bureau
• RD

  Ron Dagan, MD

  Professor of Pediatrics and Infectious Disease
  Ben-Gurion University of the Negev
  Beer Sheva, HaDarom, Israel

  Disclosure: Memed, MSD, Pfizer: Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker's Bureau

Background :

PCV13 implementation in children resulted in a substantial decline in carriage of and disease by vaccine serotypes (VT13). However, disease caused by non-PCV13 serotypes (NVT) is still relatively prevalent and even increasing, leading to an effort to develop a 20-valent vaccine (PCV20), containing the additional 7 serotypes: 8, 10A, 11A, 12F, 15B/C, 22F, 33F (VT20-13).
We assessed dynamics of VT13, VT20-13 and non-PCV20 (NVT20) in nasopharyngeal carriage, respiratory infections and IPD in children < 2y following PCV13 implementation.

Methods :

Multiple prospective, population-based surveillance projects, conducted in Israel between 2009 and 2017 were used. We studied isolates from IPD; otitis media (OM); conjunctivitis; carriage in healthy children; carriage during lower respiratory tract infections with chest radiography examination (LRI); and carriage during non-LRI illnesses. We added data from healthy children in the community since 2011.
Prevalence rate ratios were calculated, comparing VT13, VT20-13 and NVT20 rates in late-PCV13 (2015-2017) vs. early-PCV (2009-2011) periods.

Results : Overall, 9,089 episodes were recorded. VT13 declined significantly in all 6 groups by 75-86% (Figure 1, 2). Proportions of VT20-13 significantly increased in all groups, excluding conjunctivitis.  The highest increases were observed in IPD, OM and carriage during LRI. In 2015-17, VT20-13 consisted 24%, 23% and 19% of carriage in healthy children, carriage in non-LRI illness, and conjunctivitis, respectively, vs. 51%, 33% and 32% in IPD, OM, and carriage during LRI. VT20-13 rapidly became the leading fraction in IPD. NVT20 proportions increased in all groups.

Conclusion : 1) PCV13 implementation resulted in a substantial increase in NVT carriage and disease; 2) In IPD, VT20-13 became the dominant group; 3) The increases in the proportion of VT20-13 seen in OM and carriage during LRI was significantly higher than in conjunctivitis and in carriage without LRI.