Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: The PSERENADE project

J Infect. 2025 Mar;90(3):106426. doi: 10.1016/j.jinf.2025.106426. Epub 2025 Jan 27.

Abstract

Background: Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally.

Methods: The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally. Site-specific meningitis incidence rate ratios (IRRs) comparing pre-PCV incidence to each year post-PCV10/13 were estimated by age (<5, 5-17 and ≥18 years) using Bayesian multi-level mixed effects Poisson regression, accounting for pre-PCV trends. All-site weighted average IRRs were estimated using linear mixed-effects regression stratified by age, product (PCV10 or PCV13) and prior PCV7 impact (none, moderate, or substantial). Changes in pneumococcal meningitis incidence were estimated overall and for product-specific vaccine-types and non-PCV13-types.

Results: Analyses included 10,168 cases <5 y from PCV13 sites and 2849 from PCV10 sites, 3711 and 1549 for 5-17 y and 29,187 and 5653 for ≥18 y from 42 surveillance sites (30 PCV13, 12 PCV10, 2 PCV10/13) in 30 countries, primarily high-income (84%). Six years after PCV10/PCV13 introduction, pneumococcal meningitis declined 48-74% across products and PCV7 impact strata for children <5 y, 35-62% for 5-17 y and 0-36% for ≥18 y. Impact against PCV10-types at PCV10 sites, and PCV13-types at PCV13 sites was high for all age groups (<5 y: 96-100%; 5-17 y: 77-85%; ≥18 y: 73-85%). After switching from PCV7 to PCV10/13, increases in non-PCV13-types were generally low to none for all age groups.

Conclusion: Pneumococcal meningitis declined in all age groups following PCV10/PCV13 introduction. Plateaus in non-PCV13-type meningitis suggest less replacement than for all IPD. Data from meningitis belt and high-burden settings were limited.

Keywords: Incidence; Indirect protection; Pneumococcal conjugate vaccines; Pneumococcal meningitis; Serotype replacement; Serotypes; Vaccine impact.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Female
  • Global Health / statistics & numerical data
  • Humans
  • Immunization Programs
  • Incidence
  • Infant
  • Male
  • Meningitis, Pneumococcal* / epidemiology
  • Meningitis, Pneumococcal* / prevention & control
  • Middle Aged
  • Pneumococcal Vaccines* / administration & dosage
  • Serogroup
  • Streptococcus pneumoniae* / immunology
  • Vaccines, Conjugate / administration & dosage
  • Young Adult

Substances

  • Pneumococcal Vaccines
  • 13-valent pneumococcal vaccine
  • 10-valent pneumococcal conjugate vaccine
  • Vaccines, Conjugate