Impact of childhood immunisation with a pneumococcal conjugate ...

IPD surveillance, use and effectiveness
of PCVs in the Nordic countries
Creating a platform for joint studies ?
Didrik F. Vestrheim
Division of Infectious Disease Control
Norwegian Institute of Public Health

Nordic countries
Denmark 5,6
Finland 5,4
Iceland 0,3
Norway 5,0
Sweden 9,5
Total 25,8

Aims
• Map out current IPD surveillance and use of PCVs in
the Nordic countries
• Describe and discuss similarities and differences
– Description can be used as platform for collaboration
• Explore the potential for joint studies
… trigger further discussion

Methods and approach
• Informal exchange of ideas
• Questionnaire to Nordic public health institutes
– June 2012
• Data available at national web-sites

Surveillance of IPD – epi
Denmark
Infectious disease
register
1938 (lab-based),
1980 (meningitis)
Notification
Lab and clinician
(men/IPD < 5 yr)
Clinical
data
(Y)/N
Finland 1995 Lab N
Iceland
1990, notifiable
from 2009
Clinician and lab
Y/N
Norway 1977 Clinician and lab (Y)/N
Sweden
Notifiable from July
2004
Clinician and lab
Y/N

Surveillance of IPD – lab
Serotyping
performed
Appr. available
proportion
Susceptibility
testing
Denmark 1938 90-95 % Yes
Finland 1993 90-95 % Yes
Iceland 1990 90-95 % Yes
Norway 1980 90-95 % Yes
Sweden
1987, complete
data from 2006
90-95 % Yes

Use of PCVs in the Nordic countries
• PCV = pneumococcal conjugate vaccine
– PCV7 4, 6B, 9V, 14, 18C, 19F, 23F
– PCV10 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F
– PCV13 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F, 3, 6A, 19A
• PCVs included in National Immunisation Programmes
in all Nordic countries
– Time of introduction and vaccine used differs between sites
• The Nordic 2+1 dose immunisation schedule
– 3, 5 and 12 months

Use of PCVs in the Nordic countries
2006 2007 2008 2009 2010 2011 2012
Denmark
PCV7
PCV13
Finland
Iceland
Phase IV clinical trial of
PCV10. 75% of healthy
baby clinics → 2/3
PCV10
PCV10
FinIP
PCV10
Norway
PCV7
PCV13
Sweden
Starting in 2007 in
some regions
PCV7
PCV13 / PCV10

Vaccine uptake
• Administration of immunisations
– Healthy baby clinics (Norway, Finland, Ideland, Sweden)
– GPs (Denmark)
• Surveillance of vaccine uptake
– Surveys
• Finland (shift to register 2012)
• Sweden (data collected from healthy baby clinics)
– Database
• Iceland, Norway, Sweden (selected regions),
Finland (starting 2012), Denmark

No. of cases / 100,000 population
IPD in the Nordic countries
30
Iceland Sweden Finland Denmark Norway
25
20
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Overall IPD incidence rates

No. of cases / 100,000 population
Norway
Iceland Sweden Finland Denmark Norway
30
25
PCV7
20
PCV13
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No. of cases / 100,000 population
Denmark
Iceland Sweden Finland Denmark Norway
30
25
PCV7
PCV13
20
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No. of cases / 100,000 population
Finland
Iceland Sweden Finland Denmark Norway
30
25
PCV10
20
FinIP
NIP
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No. of cases / 100,000 population
Sweden
Iceland Sweden Finland Denmark Norway
30
25
20
PCV7
PCV10
and
PCV13
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No. of cases / 100,000 population
Iceland
Iceland Sweden Finland Denmark Norway
30
25
20
15
PCV10
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No. of cases / 100,000 population
IPD in the Nordic countries
30
Iceland Sweden Finland Denmark Norway
25
20
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Overall IPD incidence rates

IPD in the Nordic countries
• Direct and indirect vaccine effectiveness
– Selected data

No. of cases / 100,000 population
Norway
Children < 2 years – direct effect
PCV7 PCV13 - additional serotypes Not PCV13 - serotypes
70
60
PCV7
PCV13
50
40
30
20
10
0
2004 2005 2006 2007 2008 2009 2010 2011

No of cases / 100,000 population
Norway
Adults ≥ 65 years – indirect effect
PCV7 PCV13 - additional serotypes Not PCV13 - serotypes
50
45
PCV7
PCV13
40
35
30
25
20
15
10
5
0
2004 2005 2006 2007 2008 2009 2010 2011

No. of cases per 100,000 population
Denmark
Children < 2 years – direct effect
PCV7-serotypes
PCV13-additional serotypes
50
45
Not-PCV7/PCV13 serotypes
PCV7
PCV13
40
35
30
25
20
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Denmark
Adults ≥ 65 years – indirect effect
PCV7
PCV13

Denmark
• Visit poster
– Harboe Z.B. et al

Finland

Finland
• Visit posters
– Results from FinIP
– Palmu A. et al
– NVP surveillance
– Jokinen J. et al

Sweden

Why compare and collaborate?
• To improve surveillance data
– Reveal weakness of surveillance systems
– Explain differences between datasets
• Prepare for future changes in pneumococcal
immunisation?
– Next generation pneumococcal vaccines Pneumococcal
carriage as a proxy for effectiveness?

Why compare and collaborate?
• Focus on what we are lacking
– Increase the statistical power
– Risk associated with underlying conditions
– Case-fatality, stratified by underlying conditions
• We need high quality clinical data
– Trends for non-invasive disease
– Surveillance of infectious reservoir
→ Collaborate to gain momentum and financing

How?
• Description of surveillance, sociodemographic and
economic factors
– Platform
• Co-ordinated studies
– Comparison at national level
• meta-analyses of national data
• Parallel publications
– … or at individual case level?

Conclusions
• Extensive surveillance of IPD and PCVs ongoing in all
Nordic countries
• Differences and similarities
• Potential for collaboration
… work in progress

Acknowledgements
Zitta B. Harboe, Tine Dalby, Palle Valentiner-Branth,
Jukka Jokinen, Arto Palmu, Hanna Nohynek, Anni
Virolainen-Julkunen, Thorolfur Gudnason, Karl
Kristinsson, Eva Morfeldt, Birgitta Henriques-
Normark, Marianne Bergsaker, Anneke Steens
….. and many more from the national IPD
surveillance teams