Towards the 13-valent pneumococcal conjugate universal vaccination

Figures & data

Table 1. Italian national recommendations for PCV13 immunization schedule in newborns and in children <60 mo of age

	3 mo	5 mo	12 mo	12–15 mo	16–24 mo	24–60 mo
Children never vaccinated with PCV7
Newborns	PCV13	PCV13	PCV13
Children between 12 and 23 mo of age				2 PCV13 doses with an interval of at least two months
Children between 2 and 5 y of age						1 PCV13 dose
Children ≤24 mo of age who had received ≥1 PCV7 dose (sequential and catch up schedule)
1 PCV7 dose	PCV7	PCV13	PCV13
2 PCV7 doses	PCV7	PCV7	PCV13
3 PCV7 doses	PCV7	PCV7	PCV7		PCV13
Children <60 mo of age with underlying medical conditions who had received ≥1 PCV7 dose
1 PCV7 dose	PCV7	PCV13	PCV13	PCV13
2 PCV7 doses	PCV7	PCV7	PCV13	PCV13
3 PCV7 doses	PCV7	PCV7	PCV7	PCV13	PCV13
Children between 2 and 5 y of age	PCV7	PCV7	PCV7			2 PCV13 doses with an interval of at least two months

Table 2. Description of enrolled patients (n = 159) by demographics, clinical picture, outcome, and risk factors, according to vaccination history, Apulia region, Italy, May 2010–January 2013

	Adequately PCV7 vaccinated	Adequately PCV13 vaccinated	Partially PCV7 or PCV13 vaccinated	Not vaccinated	Total	P
	n = 73	n = 51	n = 12	n = 23
	N (%)	N (%)	N (%)	N (%)
Demographics
Sex (Male)	36 (49.32)	25 (49.02)	7 (58.33)	15 (65.22)	83 (52.20)	n.s.
Age (≤ 24 mo)	21 (28.77)	34 (66.67)	4 (33.33)	18 (78.26)	77 (48.43)	<0.001
Clinical picture
Sepsis	29 (39.73)	21 (41.18)	2 (16.67)	10 (43.48)	62 (38.99)	n.s.
Meningitis	2 (2.74)	1 (1.96)	1 (8.33)	1 (4.35)	5 (3.14)	n.s.
Pneumonia	37 (50.68)	21 (41.18)	9 (75.00)	8 (34.78)	75 (47.17)	n.s.
Outcome
Healing with sequelae	2 (2.74)	0	1 (8.33)	0	3 (1.88)	n.s.
Risk factors
Co-morbiditis*	8 (10.96)	6 (11.76)	3 (25.00)	1 (4.35)	18 (11.32)	n.s.
Contact with other invasive disease cases	15 (20.55)	5 (9.80)	0	3 (13.04)	23 (14.47)
Recent trips	4 (5.48)	1 (1.96)	1 (8.33)	2 (8.70)	8 (5.03)	n.s.
Attending a community**	43 (58.90)	12 (23.53)	6 (50.00)	5 (21.74)	66 (41.51)	0.003

*i.e., Pulmonary, cardiovascular, neurological, gastrointestinal, endocrinal disease, etc.; **i.e., Kindergarten; n.s., P > 0.05

Table 3. Confirmed IPD cases by enrollment date, sex, age, clinical picture, vaccination history, sample type, and isolated serotypes, Apulia region, Italy, May 2010–January 2013

	Enrollment date	Sex	Age (mo)	Clinical picture	Vaccination history	Sample type	Isolated serotypes
Case 1	October 2010	Female	32	Pneumonia	3 PCV7 doses	Blood	9V
Case 2	February 2011	Male	23	Pneumonia	3 PCV7 doses + 1 PCV13 dose	Blood	9V
Case 3	December 2011	Female	1	Meningitis	No	CSF*	3
Case 4	January 2012	Male	12	Meningitis	2 PCV13 doses	CSF	15 B/C

*CSF, cerebro spinal fluid.

Figure 1. Hospitalization rate ratio for IPD, Streptococcus pneumoniae pneumonia, all-cause pneumonia, and AOM, by time period (baseline, PCV7 vaccination era, PCV7/PCV13 transition era), Apulia region, Italy, 2001–2011.

Table 4. Hospitalization rates per 100 000, rate ratios (RRs), and 95% CIs for IPD, Streptococcus pneumoniae pneumonia, all-cause pneumonia, and AOM between the pre-PCV years and the whole vaccination period, Apulia region, Italy

	2001–2005		2006–2011
	N	Rate per 100 000	N	Rate per 100 000	RR	CI 95%
IPD	6.4	3.1	4.3	2.2	0.72	0.21–2.43
Pneumococcal pneumonia	25.2	12.3	10.3	5.4	0.43	0.21–0.90
All-cause pneumonia	1680.4	820.8	1456	754.4	0.92	0.86–0.99
Suppurative and unspecified otitis media	419.6	204.8	298.5	154.7	0.75	0.65–0.88