Background
Methods
The PPV23 vaccination program and vaccine coverage
Data sources
Statistical analysis
Ethical statement
Results
Incidence of IPD by age group and vaccine serotype
Age Group | Serotype | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 | 2015–2016 | Trend test p value | July 2008–June 2013 incidence | July 2008–June 2013 incidence | 2013–2016 vs. 2008–2013 RR | (95% CI) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
≤5 | n = 167 | n = 175 | n = 249 | n = 206 | n = 180 | n = 101 | n = 87 | n = 75 | n = 977 | n = 263 | ||||
Total cases | 13.32 | 14.33 | 21.23 | 17.70 | 15.13 | 8.51 | 7.25 | 6.14 | <.0001 | 16.28 | 7.29 | 0.45 | (0.39–0.51) | |
PCV13 VT | 12.20 | 12.94 | 19.53 | 15.46 | 12.10 | 5.90 | 3.00 | 2.86 | <.0001 | 14.40 | 3.91 | 0.27 | (0.23–0.32) | |
PPV23 VT | 11.80 | 12.12 | 18.51 | 14.77 | 11.93 | 5.48 | 3.41 | 3.19 | <.0001 | 13.78 | 4.02 | 0.29 | (0.24–0.35) | |
PPV23-non PCV13 VT | 0.24 | 0.08 | 0.09 | 0.17 | 0.42 | 0.25 | 0.58 | 0.49 | 0.013 | 0.20 | 0.44 | 2.22 | (1.05–4.69) | |
Non-PCV13 | 1.12 | 1.39 | 1.71 | 2.23 | 3.03 | 2.61 | 4.25 | 3.27 | <.0001 | 1.88 | 3.38 | 1.80 | (1.39–2.32) | |
19A | 2.39 | 4.26 | 8.70 | 10.05 | 8.99 | 4.13 | 2.00 | 2.13 | 0.002 | 6.80 | 2.74 | 0.40 | (0.32–0.50) | |
6–64 | n = 300 | n = 268 | n = 322 | n = 276 | n = 279 | n = 270 | n = 207 | n = 272 | n = 1445 | n = 749 | ||||
Total cases | 1.55 | 1.38 | 1.65 | 1.41 | 1.43 | 1.39 | 1.07 | 1.41 | 0.003 | 1.48 | 1.29 | 0.87 | (0.79–0.95) | |
PCV13 VT | 1.13 | 0.98 | 1.31 | 1.02 | 0.93 | 0.94 | 0.55 | 0.81 | <.0001 | 1.08 | 0.77 | 0.71 | (0.64–0.80) | |
PPV23 VT | 1.15 | 1.04 | 1.33 | 1.02 | 0.95 | 0.97 | 0.61 | 0.89 | <.0001 | 1.10 | 0.82 | 0.75 | (0.67–0.83) | |
PPV23-non PCV13 VT | 0.06 | 0.10 | 0.08 | 0.09 | 0.13 | 0.09 | 0.09 | 0.12 | 0.115 | 0.09 | 0.10 | 1.08 | (0.78–1.50) | |
Non-PCV13 | 0.42 | 0.40 | 0.34 | 0.39 | 0.50 | 0.44 | 0.51 | 0.60 | < 0.001 | 0.41 | 0.52 | 1.27 | (1.09–1.47) | |
19A | 0.03 | 0.08 | 0.18 | 0.17 | 0.21 | 0.26 | 0.07 | 0.20 | <.0001 | 0.13 | 0.18 | 1.31 | (1.02–1.70) | |
65–74 | n = 102 | n = 109 | n = 100 | n = 88 | n = 86 | n = 79 | n = 89 | n = 83 | n = 485 | n = 251 | ||||
Total cases | 7.43 | 7.83 | 7.22 | 6.31 | 6.01 | 5.31 | 5.69 | 5.03 | <.0001 | 6.95 | 5.34 | 0.77 | (0.66–0.89) | |
PCV13 VT | 5.39 | 6.18 | 5.56 | 4.80 | 4.47 | 3.56 | 2.81 | 2.72 | <.0001 | 5.28 | 3.02 | 0.57 | (0.47–0.69) | |
PPV23 VT | 6.05 | 6.54 | 6.06 | 4.88 | 4.61 | 3.90 | 3.39 | 2.91 | <.0001 | 5.62 | 3.38 | 0.60 | (0.50–0.72) | |
PPV23-non PCV13 VT | 0.73 | 0.57 | 0.94 | 0.14 | 0.42 | 0.40 | 0.64 | 0.24 | 0.067 | 0.56 | 0.43 | 0.76 | (0.44–1.30) | |
Non-PCV13 | 2.04 | 1.65 | 1.66 | 1.51 | 1.54 | 1.75 | 2.88 | 2.30 | 0.064 | 1.68 | 2.32 | 1.38 | (1.06–1.79) | |
19A | 0.15 | 0.36 | 0.36 | 0.43 | 0.84 | 0.54 | 0.70 | 0.54 | 0.026 | 0.43 | 0.60 | 1.38 | (0.83–2.32) | |
≥ 75 | n = 166 | n = 138 | n = 151 | n = 162 | n = 147 | n = 125 | n = 147 | n = 118 | n = 764 | n = 390 | ||||
Total cases | 16.11 | 12.94 | 13.70 | 14.29 | 12.57 | 10.37 | 11.82 | 9.17 | <.0001 | 13.89 | 10.44 | 0.75 | (0.67–0.85) | |
PCV13 VT | 12.52 | 9.57 | 9.71 | 10.67 | 8.12 | 7.46 | 6.75 | 5.21 | <.0001 | 10.07 | 6.45 | 0.64 | (0.55–0.75) | |
PPV23 VT | 13.69 | 10.88 | 10.52 | 10.58 | 8.29 | 7.96 | 7.07 | 5.67 | <.0001 | 10.72 | 6.88 | 0.64 | (0.55–0.74) | |
PPV23-non PCV13 VT | 1.36 | 1.41 | 1.45 | 0.71 | 0.60 | 0.75 | 0.48 | 0.62 | 0.001 | 1.09 | 0.62 | 0.56 | (0.35–0.91) | |
Non-PCV13 | 3.59 | 3.38 | 3.99 | 3.62 | 4.45 | 2.90 | 5.06 | 3.96 | 0.253 | 3.82 | 3.99 | 1.04 | (0.85–1.29) | |
19A | 0.29 | 0.19 | 0.27 | 0.71 | 1.11 | 1.08 | 0.96 | 1.09 | 0.000 | 0.53 | 1.04 | 1.98 | (1.22–3.20) | |
all ages | n = 735 | n = 690 | n = 822 | n = 732 | n = 692 | n = 575 | n = 530 | n = 548 | n = 3671 | n = 1653 | ||||
Total cases | 3.19 | 2.98 | 3.55 | 3.15 | 2.97 | 2.46 | 2.26 | 2.33 | <.0001 | 3.17 | 2.35 | 0.74 | (0.70–0.79) | |
PCV13 VT | 2.50 | 2.32 | 2.89 | 2.45 | 2.08 | 1.70 | 1.16 | 1.29 | <.0001 | 2.45 | 1.38 | 0.56 | (0.53–0.61) | |
PPV23 VT | 2.58 | 2.41 | 2.92 | 2.41 | 2.10 | 1.75 | 1.28 | 1.41 | <.0001 | 2.49 | 1.48 | 0.60 | (0.55–0.64) | |
PPV23-non PCV13 VT | 0.16 | 0.19 | 0.20 | 0.13 | 0.19 | 0.15 | 0.17 | 0.17 | 0.813 | 0.17 | 0.17 | 0.96 | (0.77–1.21) | |
Non-PCV13 | 0.69 | 0.67 | 0.66 | 0.71 | 0.89 | 0.76 | 1.11 | 1.04 | <.0001 | 0.72 | 0.97 | 1.34 | (1.21–1.48) | |
19A | 0.18 | 0.32 | 0.63 | 0.71 | 0.74 | 0.52 | 0.26 | 0.37 | 0.220 | 0.52 | 0.38 | 0.74 | (0.64–0.86) |
Characteristics of IPD in adults ≥ 75 years
Total | % | Unvaccinated | % | Vaccinated | % | p value | |
---|---|---|---|---|---|---|---|
Total IPD cases | 1154 | 100 | 776 | 100 | 378 | 100 | |
Total IPD case serotyped | 1051 | 91.1 | 716 | 92.3 | 335 | 88.6 | 0.042 |
Gender | |||||||
Female | 372 | 32.2 | 258 | 33.2 | 114 | 30.2 | 0.292 |
Male | 782 | 67.8 | 518 | 66.8 | 264 | 69.8 | 0.292 |
Onset age | |||||||
Median (min~max) | 83.1 | (75.0~106.6) | 82.8 | (75.0~106.6) | 83.5 | (75.1~99.8) | 0.002 |
75–84 | 728 | 63.1 | 499 | 64.3 | 229 | 60.6 | 0.219 |
85+ | 426 | 36.9 | 277 | 35.7 | 149 | 39.4 | 0.219 |
Clinical manifestation | |||||||
Sepsis | 621 | 53.8 | 417 | 53.7 | 204 | 54.0 | 0.941 |
Pneumonia | 776 | 67.2 | 513 | 66.1 | 263 | 69.6 | 0.239 |
Meningitis | 10 | 0.9 | 5 | 0.6 | 5 | 1.3 | 0.311 |
Others | 1081 | 93.7 | 720 | 92.8 | 361 | 95.5 | 0.108 |
Death within 30 days of IPD onset | |||||||
N | 432 | 37.4 | 287 | 37.0 | 145 | 38.4 | 0.651 |
Age, Medium (min~max) | 83.6 | (75.0~100.3) | 83.6 | (75.0~100.3) | 84.1 | (75.1~98.2) | 0.330 |
Days between onset to notification | |||||||
Median (min~max) | 5 | (0.0~64.0) | 5 | (0.0~64.0) | 5 | (0~40.0) | 0.710 |
Onset season | |||||||
2008–2009 | 166 | 14.4 | 130 | 16.8 | 36 | 9.5 | 0.001 |
2009–2010 | 138 | 12.0 | 100 | 12.9 | 38 | 10.1 | 0.164 |
2010–2011 | 151 | 13.1 | 107 | 13.8 | 44 | 11.6 | 0.310 |
2011–2012 | 162 | 14.0 | 107 | 13.8 | 55 | 14.6 | 0.727 |
2012–2013 | 147 | 12.7 | 101 | 13.0 | 46 | 12.2 | 0.686 |
2013–2014 | 125 | 10.8 | 81 | 10.4 | 44 | 11.6 | 0.538 |
2014–2015 | 147 | 12.7 | 83 | 10.7 | 64 | 16.9 | 0.003 |
2015–2016 | 118 | 10.2 | 67 | 8.6 | 51 | 13.5 | 0.011 |
Total IPD cases | 1154 | 100 | 776 | 100 | 378 | 100 | |
High risk medical conditions (HRMC) | |||||||
With HRMC | 591 | 51.2 | 378 | 48.7 | 213 | 56.3 | 0.019 |
Immunodeficiency/cancer | 240 | 20.8 | 152 | 19.6 | 88 | 23.3 | 0.147 |
COPD | 214 | 18.5 | 133 | 17.1 | 81 | 21.4 | 0.079 |
Congenital heart disease | 6 | 0.5 | 3 | 0.4 | 3 | 0.8 | 0.400 |
Splectomy/Asplenism | 2 | 0.2 | 1 | 0.1 | 1 | 0.3 | 0.548 |
Others | 189 | 16.4 | 125 | 16.1 | 64 | 16.9 | 0.723 |
Serotypes | |||||||
PCV13 VT | 795 | 68.9 | 554 | 71.4 | 241 | 63.8 | 0.009 |
PPV23 VT | 847 | 73.4 | 598 | 77.1 | 249 | 65.9 | <.0001 |
PPV23-non PCV13 VT | 83 | 7.2 | 69 | 8.9 | 14 | 3.7 | 0.001 |
Vaccine uptake
Vaccine effectiveness
IPD | VE | (95% CI) |
---|---|---|
All serotypes | ||
Crude VE | 32.4% | (23.6 to 40.2) |
Adjusted by gender | 33.2% | (24.4 to 40.9) |
Adjusted by age and gender | 33.9% | (25.2 to 41.5) |
Death within 30 days of IPD onset | ||
Crude VE | 29.9% | (14.4 to 42.6) |
Adjusted by gender | 30.8% | (15.5 to 43.4) |
Adjusted by age and gender | 32.5% | (17.5 to 44.7) |
PPV23 VT | ||
Crude VE | 42.2% | (33.0 to 50.2) |
Adjusted by gender | 42.9% | (33.8 to 50.7) |
Adjusted by age and gender | 43.4% | (34.4 to 51.2) |
PPV23-non PCV13 VT | ||
Crude VE | 71.8% | (50.0 to 84.2) |
Adjusted by gender | 72.1% | (50.5 to 84.3) |
Adjusted by age and gender | 72.6% | (51.4 to 84.6) |
PCV13 (without 6A) VT | ||
Crude VE | 38.4% | (28.1 to 47.1) |
Adjusted by gender | 39.1% | (29.0 to 47.8) |
Adjusted by age and gender | 39.6% | (29.5 to 48.2) |
IPD | Cases | Controls | Crude VE (%) | 95%CI | Adjusted VE (%) | 95%CI |
---|---|---|---|---|---|---|
Serotypes PPV23 | 847 | 204 | 42.9 | (21.7 to 58.3) | 39.0a | (15.5 to 55.9) |
75–84 | 540 | 133 | 44.9 | (18.5 to 62.8) | 42.4b | (13.7 to 61.6) |
85+ | 307 | 71 | 39.5 | (−2.5 to 64.3) | 33.9 b | (−15.2 to 62.1) |
Female | 263 | 82 | 46.1 | (9.5 to 68.0) | 38.7c | (−4.9 to 64.2) |
Male | 584 | 122 | 42.5 | (14.3 to 61.4) | 38.0c | (6.4 to 59.0) |
Without HRMC | 390 | 95 | 57.6 | (32.3 to 73.4) | 56.5d | (29.6 to 73.1) |
With HRMC | 425 | 108 | 27.5 | (−11.7 to 52.9) | 20.4d | (−24.5 to 49.1) |
> 5 years after vaccination | 668 | 143 | 44.7 | (9.1 to 66.4) | 15.5a | (−47.1 to 51.4) |
≤ 5 years after vaccination | 777 | 179 | 42.1 | (17.7 to 59.2) | 44.9a | (20.8 to 61.7) |
Serotypes PPV23-non PCV13 | 83 | 204 | 72.2 | (47.3 to 85.3) | 71.5a | (44.2 to 85.4) |
Serotype PCV13 (without 6A) | 764 | 204 | 39.0 | (16.3 o 55.6) | 35.3a | (10.1 to 53.4) |
serotype 3 | 173 | 204 | 39.4 | (7.2 to 60.4) | 36.8a | (0.4 to 59.9) |
Serotype14 | 181 | 204 | 36.9 | (4.1 to 58.5) | 38.8a | (4.1 to 61.0) |
serotype 23F | 153 | 204 | 27.3 | (−12.2 to 52.9) | 11.3a | (−42.1 to 44.7) |
serotype 19F | 69 | 204 | 40.0 | (−7.6 to 66.5) | 34.9a | (−21.3 to 65.1) |
serotype 19A | 68 | 204 | 57.8 | (21.1 to 77.4) | 56.3a | (16.1 to 77.2) |
serotype 6B | 70 | 204 | 52.5 | (13.1 to 74.0) | 51.9a | (8.1 to 74.8) |
serotype 15B | 23 | 204 | 79.4 | (28.5 to 94.1) | 80.6a | (28.6 to 94.7) |
serotype 9 V | 33 | 204 | 31.4 | (−49.0 to 68.4) | 31.3a | (−60.4 to 70.6) |
Differential vaccine effectiveness of PPV23 over time
Time since PPV23 vaccination | Cases | Controls | Crude VE (%) | 95%CI | Adjusted VE (%) | 95%CI |
---|---|---|---|---|---|---|
No vaccination | 598 | 118 | Ref. | Ref. | ||
≤ 1 years | 29 | 11 | 48.0 | (−7.0 to 74.7) | 73.7 | (39.0 to 88.7) |
> 1 and ≤ 2 years | 41 | 15 | 46.1 | (−0.6 to 71.1) | 64.4 | (29.2 to 82.0) |
> 2 and ≤ 3 years | 37 | 14 | 47.9 | (0.5 to 72.7) | 48.9 | (−1.6 to 74.3) |
> 3 and ≤ 4 years | 46 | 13 | 30.2 | (−33.3 to 63.4) | 19.2 | (−61.3 to 59.5) |
> 4 and ≤ 5 years | 26 | 8 | 35.9 | (−45.1 to 71.7) | −3.4 | (−144.9 to 56.3) |
> 5 years | 70 | 25 | 44.7 | (9.1 to 66.4) | 15.5 | (−47.1 to 51.4) |