BACKGROUND: The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Netherlands pediatric national immunization program (NIP) starting in 2011. However, there is substantial pneumococcal disease burden due to increases in non-PCV10 covered serotypes. Higher valent vaccines for pediatrics PCV13, PCV15, and PCV20 may alleviate the majority of the remaining disease burden upon implementation through broader serotype coverage. This paper assesses the public health impact of different pediatric vaccination strategies (switching to PCV13, PCV15, or PCV20) versus maintaining PCV10 at different time intervals in the Netherlands.
METHODS: A population-based, decision-analytic model was developed using historical pneumococcal disease surveillance data to forecast future invasive pneumococcal disease (IPD), pneumonia, otitis media (OM) cases under PCV10, PCV13, PCV15, and PCV20 use. Outcome comparisons were made for switching to PCV13 in the short-term (2022) and PCV15 or PCV20 in the long-term (2024) until 2028. Scenario analyses are performed to account for uncertainties in future serotype distributions, disease incidence reductions, and epidemiologic parameters.
RESULTS: In the near term (2022-2028), switching to PCV13 is found to avert 11,949 cases of pneumococcal disease compared to continuing PCV10. In the future, maintaining PCV10 and switching to PCV15 in 2024-2028 is found to avert 4,855 pneumococcal cases. Maintaining PCV10 and switching to PCV20 in 2024-2028 was estimated to avert 30,942 pneumococcal cases. Switching to PCV13 in 2022 followed by PCV20 in 2024 was estimated to avert the most cases of disease (46,736) compared to any other vaccine switching combination strategy. Overall conclusions were maintained after testing uncertainties.
CONCLUSIONS: For the Dutch pediatric NIP, switching to PCV13 in 2022, and subsequently PCV20 in 2024, was estimated to avert the most pneumococcal disease cases and provide the highest protection. However, in the face of budget constraints and the undervaluation of prevention strategies, it remains challenging to implement higher valent vaccines. Further research is needed to understand the cost-effectiveness and feasibility of a sequential approach.
