Lucas A, Wilson M, Wasserman M, Jones D, Vyse A, Slack M, Hilton B, Madhava H, Farkouh R. Dynamic transmission modeling of pneumococcal conjugate vaccine and potential dosing reduction in the United Kingdom. Poster presented at the 11th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD); April 17, 2018. Melbourne, Australia.

BACKGROUND AND AIMS: 7- and 13-valent pneumococcal conjugate vaccines (PCV) have been an effective part of routine immunization using a 2+1 schedule in the United Kingdom (UK) for the previous 11 years. Studies are ongoing to evaluate effects of removing a dose from the primary series. Our objective is to estimate health and economic impact of reducing from a 2+1 to a 1+1 PCV13 schedule.

METHODS: A dynamic transmission model was developed using UK serotype-specific invasive pneumococcal disease (IPD) surveillance data from 2001-2016. Pneumonia and otitis media cases were calculated assuming a relative proportion to IPD. Cases and costs (2016 GBP, 3.5% discounted) were calculated over a 5-year period for the entire UK population. Scenario analyses were undertaken to evaluate the impact of parameter uncertainty.

Compared with maintaining the 2+1 schedule, reducing to 1+1 was predicted to incur 8,561-25,394 additional cases of pneumococcal disease, 249-665 more deaths, and £9.9-£26.8MM additional disease-related medical costs (Table 1) across all age groups over the 5-year period. Serotype 19A IPD was responsible for 77-95% of incremental cases.

CONCLUSION: Results suggest that removal of an infant priming dose would increase pneumococcal disease cases and medical costs compared with maintaining a 2+1 schedule, with much of this increase from resurgence in 19A. It is important that policymakers consider potential public health impact when considering modifications to vaccination strategies.

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