Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project.

Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon

Primary diphtheria immunisation of adolescents and adults with low-dose vaccine, a survey of historic evidence from the literature

The Public Health Agency of Sweden carried out a literature review on diphtheria vaccinations for seronegative people above 6 years of age with an uncertain vaccine history. The aim was to harmonise national Swedish recommendations with the current World Health Organization recommendations. There was no firm conclusion about dosage. Some low-dose vaccines used in the past had suboptimal potency, while others evoked adequate levels of antitoxin after three primary doses. We concluded that low-dose diphtheria vaccines that have been approved by a national medical products agency can be used for primary vaccination against diphtheria for individuals above 6 years of age

Att förebygga kikhosta hos spädbarn : Systematisk litteraturöversikt

Allmän barnvaccination mot kikhosta återinfördes i Sverige 1996 och sedan dess har antalet rapporterade fall av kikhosta minskat dramatiskt. Sjukdomen förekommer dock fortfarande bland ovaccinerade spädbarn och bland ungdomar och vuxna. Den högsta sjukdomsincidensen i Sverige ses bland spädbarn under sex månaders ålder. Kikhosta är en allvarlig och livshotande sjukdom för spädbarn och hårdast drabbas de allra yngsta som inte har fått sin första vaccindos vid tre månaders ålder. Drygt 70 procent av dem som insjuknar behöver sjukhusvård. Flera länder har under de senaste åren rapporterat en ökning av kikhostefall i befolkningen och dödsfall på grund av kikhosta hos spädbarn. För att minska sjukdomsbördan hos spädbarnen har rekommendationer i dessa länder innefattat vaccination av vuxna runt det nyfödda barnet (kokongvaccination), vaccination av modern under sista trimestern av graviditeten och vaccination av hälso- och sjukvårdspersonal. Dessutom har man i vissa länder rekommenderat vaccination av vuxna vart tionde år. Folkhälsomyndigheten har gjort en systematisk litteraturöversikt med syfte att finna evidens enligt GRADE-metodiken för preventiva strategier som minskar förekomsten av kikhosta hos barn yngre än sex månader. De preventiva strategier som har utvärderats är a) striktare följsamhet till tidpunkten för eller tidigareläggning av första vaccindosen, b) neonatal vaccination, c) kokongvaccination, d) vaccination av gravida, e) vaccination vid 4–7 års ålder, f) vaccination vid 13–19 års ålder, och g) postexpositionsprofylax med antibiotika. Litteraturöversikten visar någon grad av evidens för att alla de utvärderade strategierna bidrar till att skydda spädbarn mot kikhosta, förutom tonårsvaccination. Det finns två vårdinsatser som redan stöds av befintliga föreskrifter och rekommendationer men som bör följas mer strikt. Tidpunkten för första vaccindosen har betydelse för skydd mot kikhosta hos spädbarn. Uträkningar från bland annat det svenska uppföljningsprogrammet talar för en väsentlig minskning av kikhosta hos barn under sex månaders ålder om första vaccindosen ges strikt vid angiven tid enligt vaccinationsschemat eller inom två veckor före den tidpunkten. Det är viktigt att vara uppmärksam på hosta i närfamiljen under barnets första levnadsmånader. Frikostig provtagning, snabb diagnostik och behandling kan förhindra dödsfall i kikhosta hos spädbarn. Tidigt insatt postexpositionsprofylax med antibiotika till spädbarn ger ett gott skydd mot klinisk kikhosta. Dessutom finns två strategier som ytterligare kan minska förekomsten av kikhosta hos spädbarn under 6 månader: Kokongvaccination Vaccination av gravida. Kokongvaccination har i några länder visat effekt vid hög anslutning och kostnadsfri vaccination. Vaccination mot kikhosta under graviditet rekommenderas i flera länder. I England har vaccination av gravida erbjudits i cirka tre års tid i vaccinationsprogram och visat god effekt bland spädbarn till vaccinerade mödrar. Uppföljning av programmet och utvärdering av långtidseffekterna pågår och resultaten publiceras allteftersom

Att förebygga kikhosta hos spädbarn : Systematisk litteraturöversikt

Allmän barnvaccination mot kikhosta återinfördes i Sverige 1996 och sedan dess har antalet rapporterade fall av kikhosta minskat dramatiskt. Sjukdomen förekommer dock fortfarande bland ovaccinerade spädbarn och bland ungdomar och vuxna. Den högsta sjukdomsincidensen i Sverige ses bland spädbarn under sex månaders ålder. Kikhosta är en allvarlig och livshotande sjukdom för spädbarn och hårdast drabbas de allra yngsta som inte har fått sin första vaccindos vid tre månaders ålder. Drygt 70 procent av dem som insjuknar behöver sjukhusvård. Flera länder har under de senaste åren rapporterat en ökning av kikhostefall i befolkningen och dödsfall på grund av kikhosta hos spädbarn. För att minska sjukdomsbördan hos spädbarnen har rekommendationer i dessa länder innefattat vaccination av vuxna runt det nyfödda barnet (kokongvaccination), vaccination av modern under sista trimestern av graviditeten och vaccination av hälso- och sjukvårdspersonal. Dessutom har man i vissa länder rekommenderat vaccination av vuxna vart tionde år. Folkhälsomyndigheten har gjort en systematisk litteraturöversikt med syfte att finna evidens enligt GRADE-metodiken för preventiva strategier som minskar förekomsten av kikhosta hos barn yngre än sex månader. De preventiva strategier som har utvärderats är a) striktare följsamhet till tidpunkten för eller tidigareläggning av första vaccindosen, b) neonatal vaccination, c) kokongvaccination, d) vaccination av gravida, e) vaccination vid 4–7 års ålder, f) vaccination vid 13–19 års ålder, och g) postexpositionsprofylax med antibiotika. Litteraturöversikten visar någon grad av evidens för att alla de utvärderade strategierna bidrar till att skydda spädbarn mot kikhosta, förutom tonårsvaccination. Det finns två vårdinsatser som redan stöds av befintliga föreskrifter och rekommendationer men som bör följas mer strikt. Tidpunkten för första vaccindosen har betydelse för skydd mot kikhosta hos spädbarn. Uträkningar från bland annat det svenska uppföljningsprogrammet talar för en väsentlig minskning av kikhosta hos barn under sex månaders ålder om första vaccindosen ges strikt vid angiven tid enligt vaccinationsschemat eller inom två veckor före den tidpunkten. Det är viktigt att vara uppmärksam på hosta i närfamiljen under barnets första levnadsmånader. Frikostig provtagning, snabb diagnostik och behandling kan förhindra dödsfall i kikhosta hos spädbarn. Tidigt insatt postexpositionsprofylax med antibiotika till spädbarn ger ett gott skydd mot klinisk kikhosta. Dessutom finns två strategier som ytterligare kan minska förekomsten av kikhosta hos spädbarn under 6 månader: Kokongvaccination Vaccination av gravida. Kokongvaccination har i några länder visat effekt vid hög anslutning och kostnadsfri vaccination. Vaccination mot kikhosta under graviditet rekommenderas i flera länder. I England har vaccination av gravida erbjudits i cirka tre års tid i vaccinationsprogram och visat god effekt bland spädbarn till vaccinerade mödrar. Uppföljning av programmet och utvärdering av långtidseffekterna pågår och resultaten publiceras allteftersom

Validation of the new Swedish vaccination register – Accuracy and completeness of register data

Objective: The aims of this study are to validate infant vaccination data in the Swedish Vaccination Register (SVR) to the Swedish administrative coverage reports, and to assess differences in register-based vaccination coverage estimates between providers using different data reporting methods. Methods: The study population included all infants born in Sweden with a Swedish Personal Identity Number during 2014 and 2015 (n = 230,220). Data on all National Immunisation Programme vaccinations administered before 24 months of age were collected from the SVR and from administrative coverage reports. Information regarding data registration methods in the SVR were collected from national and regional authorities. Coverage from health care providers using single registration methods, where vaccination data were transferred automatically from the electronic health care record to the SVR, was compared to that from providers using double registration methods where data had to be added into the SVR in a separate process. Results: For 98,4% of the study population at least one vaccination was recorded in the SVR. The coverage of 3-dose DTP-containing (87,1%) and 1 dose MMR (91,1%) in the register did not reach administrative data coverage (97,4% for 3-dose DTP-containing and 97,0% for MMR). Single registration procedures yielded significantly higher coverage than double registration procedures (92,24% vs 87,10%, p < 0,0001). A regional switch from double to single registration increased coverage from 80,0 to 95,2%. Conclusions: The SVR is a valuable data source for vaccination coverage monitoring. For research purposes, the SVR provides valuable data, since every health care provider is obliged to register all vaccine doses given within the national immunisation program. The SVR shows a high completeness validated by comparison to a very well-functioning administrative data system. Single-registration procedures give more complete data and should be supported by health systems while creating health care registers

Cost-effectiveness of pneumococcal vaccination for elderly in Sweden

Introduction: The aim was to assess cost-effectiveness of including pneumococcal vaccination for elderly in a national vaccination programme in Sweden, comparing health-effects and costs of pneumococcal related diseases with a vaccination programme versus no vaccination. Method: We used a single-cohort deterministic decision-tree model to simulate the current burden of pneumococcal disease in Sweden. The model accounted for invasive pneumococcal disease (IPD) and pneumonia caused by pneumococci. Costs included in the analysis were those incurred when treating pneumococcal disease, and acquisition and administration of the vaccine. Health effects were measured as quality-adjusted life years (QALY). The time-horizon was set to five years, both effects and costs were discounted by 3% annually. Health-effects and costs were accumulated over the time-horizon and used to create an incremental cost-effectiveness ratio. The 23-valent polysaccharide vaccine (PPV23) was used in the base-case analysis. The 13-valent pneumococcal conjugate vaccine PCV13 was included in sensitivity analyses. Results: A vaccination programme using PPV23 would reduce the burden of pneumococcal related disease significantly, both when vaccinating a 65-year-old cohort and a 75-year-old cohort. IPD would decrease by 30% in the 65-year-old cohort, and by 29% in the 75-year-old cohort. The corresponding figures for CAP (communicable acquired pneumonia) are 19% and 15%. The cost per gained QALY was estimated to EUR 94,000 for vaccinating 65-year-olds and EUR 29,500 for 75-year-olds. With one dose PCV13 given instead of PPV23, the cost per gained QALY would increase by around 400% for both cohorts. The results were robust in sensitivity analyses. Conclusion: Introducing a vaccination programme against pneumococcal disease for 65-year-olds in Sweden is unlikely to be cost-effective, whereas it for 75 year-olds and using PPV23 can be considered good value for money. Our model indicates that vaccine price needs to be reduced by 55% for vaccination of 65-year-olds to be cost-effective, given a threshold of EUR 50,000

Mode of HPV vaccination delivery and equity in vaccine uptake : A nationwide cohort study

Ten years after its introduction, equity in human papillomavirus (HPV) vaccine uptake remains unattained, not least for the groups at highest risk of cervical cancer. In Sweden, three different delivery modes of the vaccine have been in effect since May 2007. We used this as a natural experiment to investigate girls’ HPV vaccine uptake in relation to parental country of birth and socioeconomic characteristics, by mode of delivery. Our nationwide study cohort comprised 689,676 girls born between 1990 and 2003. Data on HPV vaccination of the girls and parental birth/socioeconomic characteristics were retrieved from national registers. We examined the association between girls’ vaccine uptake and parental characteristics, stratified by mode of delivery. The cumulative uptake of at least one dose of HPV vaccine was 37%, 48% and 79% for subsidised opportunistic, free-of-charge catch-up outside-school and free-of-charge school-based vaccination, respectively. In the subsidised vaccination, having parents born outside of Sweden, with low education and low family income was strongly associated with lower uptake [HR (95% confidence interval (CI)) = 0.49 (0.48–0.50), 0.32 (0.31–0.33), 0.53 (0.52–0.54), respectively]. The associations were partially reduced in catch-up outside-school, and strongly reduced in school-based vaccination delivery [HR (95% CI) =0.82 (0.81–0.83), 0.92 (0.91–0.94), 0.87 (0.85–0.88), respectively]. Free-of-charge school-based HPV vaccination achieved the highest uptake and displayed the least disparity in country of birth and socioeconomic background of the parents. This appears to be the most effective and equitable delivery mode for reaching high population vaccination coverage, including high-risk groups for cervical cancer

Efficacy and effectiveness of pneumococcal vaccination in adults – a second update of the literature. The review is a collaboration between Public Health Institutes in Norway, Sweden and Denmark

Introduction Young children, elderly and persons with weakened immune systems are at high risk of acquiring invasive pneumococcal disease and pneumococcal pneumonia. Two different vaccines have been used for the prevention of pneumococcal disease in adults: a 23-valent polysaccharide vaccine (PPV23), and a 13-valent conjugated vaccine (PCV13). New higher-valency pneumococcal conjugate vaccines have been licensed for use in adults 18 years or older based on immunogenicity data. No clinical effectiveness data are so far available, and these vaccines are not part of this report. Methods The report covers publications on PCV13 and PPV23 efficacy and effectiveness from 2000 until February 2021 from randomized controlled trials and observational studies. Outcomes include invasive pneumococcal disease and pneumococcal pneumonia. Results A total of 32 publications are included: 22 publications on PPV23 effectiveness, nine publications on PCV13 effectiveness and one publication reporting PPV23 and PCV13 effectiveness. No study compared the effectiveness of PPV23 and PCV13 head-to-head. One large trial with overall healthy elderly dominates the evidence for PCV13 efficacy and effectiveness. The evidence for PPV23 vaccine effectiveness, on the other hand, is based on trials of moderate quality and several observational studies. Differences in populations, study designs and time since vaccination makes it difficult to summarize available evidence into single quantitative measures. The vaccine effectiveness of PPV23 in preventing invasive pneumococcal disease was consistent with past systematic reviews and similar to the estimates that have been reported for PCV13 efficacy and effectiveness. Consistent effects were reported across observational studies and ecological studies of surveillance data for the general elderly population. PCV13 seems to provide better protection than PPV23 against vaccine-type invasive pneumococcal disease (for serotypes common to PCV13 and PPV23). We found both PPV23 and PCV13 to be effective in preventing pneumococcal pneumonia in elderly at comparable levels. The PPV23 vaccine effectiveness was higher in clinical trials than observational studies, possibly reflecting a shorter follow-up time and a more limited impact of waning immunity. Both PPV23 and PCV13 showed generally lower effectiveness with increasing age for all outcomes and in groups with immunocompromising conditions. Overall, significant VE was not shown for immunocompromised groups. Conclusion This report shows that both PCV13 and PPV23 provide prevention for invasive disease and pneumococcal pneumonia in the elderly. The overall body of evidence shows PPV23 effectiveness at a level comparable to PCV13. This finding is of paramount importance for public health due to the high pneumococcal pneumonia disease burden. The serotype distribution in carriage and disease is important to consider for the impact of vaccination. The currently low proportion of patients falling ill with serotypes included in PCV13 suggests limited potential for prevention from adult PCV13 vaccination. Well-designed and serotype specific randomized controlled trials are important to improve evidence