The potential impact of pneumococcal conjugate vaccine in Africa: Considerations and early lessons learned from the South African experience

Figures & data

Figure 1. Comparison of Geometric Mean Concentrations following 2 and 3 doses of PCV7 using different immunization schedules in HIV-uninfected children Comparison of antibody GMCs following vaccination with PCV7 administered either at 6, 10 and 14 weeks of age or at 6 and 14 weeks of age with a booster at 40 weeks of age. GMCs were assessed post-second and post-third dose in the series. GMCs: Geometric Mean Concentrations, PCV7: 7-valent Pneumococcal Conjugate Vaccine. Figure taken from.³⁸

Figure 2. Comparison of Geometric Mean Concentrations following 2 and 3 doses of PCV7 in HIV-uninfected and HIV-infected children (A) Comparison of antibody GMCs following vaccination with PCV7 administered at 6 and 10 weeks of age in HUU, HEU, ART+ and ART- children. (B) Comparison of antibody GMCs following vaccination with PCV7 administered at 6, 10 and 14 weeks of age in HUU, HEU, ART+ and ART- children. GMCs: Geometric Mean Concentrations, PCV7: 7-valent Pneumococcal Conjugate Vaccine; HUU: HIV-uninfected children born to HIV-uninfected mothers; HEU: HIV-uninfected children born to HIV-infected mothers; ART+: HIV-infected children with CD4+ ≥ 25% at enrolment randomized to initiate anti-retroviral treatment (ART) immediately; ART−: HIV-infected children with CD4+ ≥ 25% at enrolment randomized to deferred ART.

Table 1. Vaccine efficacy and effectiveness of pneumococcal conjugate vaccine in South African HIV-infected and HIV-uninfected children against invasive pneumococcal disease

Study and Outcome	Vaccine efficacy/Effectiveness estimates: percent (95%CI)
	HIV-uninfected children	HIV-infected children
PCV9-efficacy trial^1 (2.3 y average follow-up)
PCV9-serotype IPD	83 (39 to 97)	65 (24 to 86)
Non-PCV9 serotype IPD	−300^4 (−19,599 to 60)	−13 (−235 to 62)
All serotype IPD	42 (−28 to 75)	53 (21 to 73)
PCV9-efficacy trial^1 (6.2 y average follow-up)
PCV9-serotype IPD	79 (34 to 93)	39 (−8 to 65)
Non-PCV9 serotype IPD	−75 (−97 to 123)	−27 (−71 to 80)
All serotype IPD	46 (19 to 64)	35 (−31 to 68)
PCV7 Case-Control study^2 (Vaccine effectiveness in children ≥16 weeks who received ≥2 doses PCV)
PCV7-serotype IPD	74 (25 to 91)	−12 (−449 to 77)
Non-PCV7 serotype IPD	−76 (−384 to 36)	−190 (−2997 to 73)
All serotype IPD	29 (−27 to 60)	6 (−194 to 70)
PCV7/PCV13 Time-series^3 (Percent decrease incidence pre-PCV era vs. PCV13 era; <2 y age)
PCV7-serotype IPD	85 (79 to 89)	86 (62 to 95)
PCV13-serotype IPD	34 ( 7 to 53)	72 ( 44 to 88)
Non-PCV13 serotype IPD	−33 (−48 to −15)	31 (−11 to 59)
All serotype IPD	50 (42 to 56)	77 (70 to 83)

¹ PCV9: 9-valent PCV (serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F). Dosing Schedule at 6, 10 and 14 weeks and no booster dose;

² PCV7: 7-valent PCV (serotypes 4, 6B, 9V, 14, 18C, 19F, 23F). Dosing schedule at 6, 14 and 40 weeks.

³ PCV13: 13-valent PCV (serotypes same as PCV9 plus 3, 6A, 7F and 19A). Dosing schedule at 6, 14 and 40 weeks.

⁴ Negative value implies an increase in IPD.

Jones SA, Groome M, Koen A, Van Niekerk N, Sewraj P, Kuwanda L, Izu A, Adrian PV, Madhi SA. Immunogenicity of seven-valent pneumococcal conjugate vaccine administered at 6, 14 and 40 weeks of age in South african infants. PLoS One 2013; 8(8):e72794; PMID:24015277; http://dx.doi.org/10.1371/journal.pone.0072794

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