Predicting the epidemiological effects in the United Kingdom of moving from PCV13 to PCV15 in the routine pediatric 1+1 vaccination schedule

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Abstract
Introduction: In 2020 the UK National Immunization Programme reduced the pediatric dosing schedule for pneumococcal vaccination with PCV13 from 2 doses in infancy followed by a toddler dose (2+1 schedule) to 1 dose in infancy followed by a toddler dose (1+1 schedule). Real world data on vaccine effectiveness (VE) against invasive pneumococcal disease (IPD) under the reduced dosing schedule is not available, nor is data on VE associated with higher valency vaccines, including PCV15. This analysis investigates changes in projected disease outcomes associated with potential reductions in VE against IPD with PCV13 and PCV15 under the 1+1 reduced dosing schedule. Methods: A previously published dynamic transmission model was employed to project population-level IPD incidence under 1+1 pneumococcal vaccination dosing of children <2 years old with two different vaccine formulations, with maintenance of current adult and at-risk vaccination programs, under a range of assumptions regarding reduction of VE against IPD, over a 20-year timeline following the switch to the 1+1 schedule. A probabilistic sensitivity analysis was performed to evaluate the sensitivity of model outcomes to potential changes in VE against IPD. Results: Relative to 2019 estimates, overall IPD incidence was predicted to increase over the time horizon for both PCV13 and PCV15 programs, however vaccination with PCV15 was estimated to lead to a smaller increase over all age groups than vaccination with PCV13. Both vaccine formulations led to projected decreases in IPD attributed to common PCV13/PCV15 serotypes in children <2 years old. Sensitivity analyses reflect results were robust to potential changes in VE against IPD. Conclusions: The current analysis predicts switching the routinely administered pediatric pneumococcal vaccine from PCV13 to PCV15 within the UK’s 1+1 dosing schedule would not only reduce IPD in the pediatric population but would also lead to population-level reductions in IPD due to indirect protection.
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