Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis.

June 29, 2025

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Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis.

Publicated to:The Lancet. Infectious diseases. 25 (4): 445-456 - 2025-04-01 25(4), DOI: 10.1016/s1473-3099(24)00588-7

Authors: Garcia Quesada M; Peterson ME; Bennett JC; Hayford K; Zeger SL; Yang Y; Hetrich MK; Feikin DR; Cohen AL; von Gottberg A; van der Linden M; van Sorge NM; de Oliveira LH; de Miguel S; Yildirim I; Vestrheim DF; Verani JR; Varon E; Valentiner-Branth P; Tzanakaki G; Sinkovec Zorko N; Setchanova LP; Serhan F; Scott KJ; Scott JA; Savulescu C; Savrasova L; Reyburn R; Oishi K; Nuorti JP; Napoli D; Mwenda JM; Muñoz-Almagro C; Morfeldt E; McMahon K; McGeer A; Mad'arová L; Mackenzie GA; Eugenia León M; Ladhani SN; Kristinsson KG; Kozakova J; Kleynhans J; Klein NP; Kellner JD; Jayasinghe S; Ho PL; Hilty M; Harker-Jones MA; Hammitt LL

Affiliations

Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Anchorage, AK, USA. - Author

Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, NHS Greater Glasgow and Clyde, Glasgow, UK. - Author

Central Laboratory of Public Health, Asunción, Paraguay. - Author

Centre for Disease Control, Department of Health and Community Services, Darwin, NT, Australia. - Author

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesb - Author

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johan - Author

CIBER de Enfermedades Respiratorias, Madrid, Spain; Epidemiology Department, Dirección General de Salud Pública, Madrid, Spain. - Author

CIBER Epidemiología y Salud Pública, Madrid, Spain; Medicine Department, International University of Catalunya, Barcelona, Spain; Molecular Microbiology Department, Hospital Sant Joan de Déu Research Institute, Barcelona, Spain. - Author

Clinical Bacteriology Service, Department of Bacteriology, National Institute for Infectious Diseases (INEI-ANLIS) "Dr Carlos G Malbrán", Buenos Aires, Argentina. - Author

Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia. - Author

Department of Clinical Microbiology, Landspitali-The National University Hospital, Reykjavik, Iceland. - Author

Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland; Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland. - Author

Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China. - Author

Department of Microbiology Public Health Agency of Sweden, Solna, Sweden. - Author

Department of Pediatrics, University of Calgary and Alberta Health Services, Calgary, AB, Canada. - Author

Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, CT, USA. - Author

Department of Public Health, Ministry of Health and Care Services, Oslo, Norway. - Author

Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya; Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, US Centers for Disease Control and Prev - Author

Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya. - Author

Epidemiology Department, Epiconcept, Paris, France. - Author

Immunisation and Countermeasures Division, UK Health Security Agency, London, UK. - Author

Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark. - Author

Institute of Public Health, Riga Stradiņš University, Riga, Latvia. - Author

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. - Author

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: mgarci64@jhmi.edu. - Author

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya. - Author

Medical Microbiology and Infection Prevention, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands. - Author

Murdoch Children's Research Institute, Parkville, VIC, Australia. - Author

National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia. - Author

National Institute of Public Health, Prague, Czech Republic. - Author

National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece. - Author

National Reference Centre for Pneumococcal and Haemophilus Diseases, Regional Authority of Public Health, Banská Bystrica, Slovakia. - Author

National Reference Centre for Pneumococci, Data Research Department, Intercommunal Hospital of Créteil, Créteil, France. - Author

New Vaccines Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, - Author

Pan American Health Organization, WHO, Washington, DC, USA. - Author

Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany. - Author

Swiss National Reference Centre for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland. - Author

Toronto Invasive Bacterial Diseases Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. - Author

Toyama Institute of Health, Toyama, Japan. - Author

University Multiprofile Hospital for Active Treatment Saint Ivan Rilski, Clinical Microbiology Laboratory, Sofia, Bulgaria. - Author

Vaccine Study Center, Kaiser Permanente, Oakland, CA, USA. - Author

WHO Regional Office for Africa, Brazzaville, Republic of the Congo. - Author

WHO, Geneva, Switzerland. - Author

Abstract

BackgroundWidespread use of pneumococcal conjugate vaccines (PCVs) has reduced vaccine-type invasive pneumococcal disease (IPD). We describe the serotype distribution of IPD after extensive use of ten-valent PCV (PCV10; Synflorix, GSK) and 13-valent PCV (PCV13; Prevenar 13, Pfizer) globally.MethodsIPD data were obtained from surveillance sites participating in the WHO-commissioned Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project that exclusively used PCV10 or PCV13 (hereafter PCV10 and PCV13 sites, respectively) in their national immunisation programmes and had primary series uptake of at least 70%. Serotype distribution was estimated for IPD cases occurring 5 years or more after PCV10 or PCV13 introduction (ie, the mature period when the serotype distribution had stabilised) using multinomial Dirichlet regression, stratified by PCV product and age group (<5 years, 5-17 years, 18-49 years, and ≥50 years).FindingsThe analysis included cases occurring primarily between 2015 and 2018 from 42 PCV13 sites (63 362 cases) and 12 PCV10 sites (6806 cases) in 41 countries. Sites were mostly high income (36 [67%] of 54) and used three-dose or four-dose booster schedules (44 [81%]). At PCV10 sites, PCV10 serotypes caused 10·0% (95% CI 6·3-12·9) of IPD cases in children younger than 5 years and 15·5% (13·4-19·3) of cases in adults aged 50 years or older, while PCV13 serotypes caused 52·1% (49·2-65·4) and 45·6% (40·0-50·0), respectively. At PCV13 sites, PCV13 serotypes caused 26·4% (21·3-30·0) of IPD cases in children younger than 5 years and 29·5% (27·5-33·0) of cases in adults aged 50 years or older. The leading serotype at PCV10 sites was 19A in children younger than 5 years (30·6% [95% CI 18·2-43·1]) and adults aged 50 years or older (14·8% [11·9-17·8]). Serotype 3 was a top-ranked serotype, causing about 9% of cases in children younger than 5 years and 14% in adults aged 50 years or older at both PCV10 and PCV13 sites. Across all age and PCV10 or PCV13 strata, the proportion of IPD targeted by higher-valency PCVs beyond PCV13 was 4·1-9·7% for PCV15, 13·5-36·0% for PCV20, 29·9-53·8% for PCV21, 15·6-42·0% for PCV24, and 31·5-50·1% for PCV25. All top-ten ranked non-PCV13 serotypes are included in at least one higher-valency PCV.InterpretationThe proportion of IPD due to serotypes included in PCVs in use was low in mature PCV10 and PCV13 settings. Serotype distribution differed between PCV10 and PCV13 sites and age groups. Higher-valency PCVs target most remaining IPD and are expected to extend impact.FundingBill & Melinda Gates Foundation as part of the WHO Pneumococcal Vaccines Technical Coordination Project.

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Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

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Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis.

Affiliations

Abstract

Keywords

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

Impact and social visibility