Association of Pneumococcal Conjugate Vaccine Coverage With Pneumococcal Meningitis: An Analysis of French Administrative Areas, 2001–2016

Anna Alari (1) , Felix Cheysson (1, 2) , Lénaig Le Fouler (1) , Philippe Lanotte (3) , Emmanuelle Varon (4) , Lulla Opatowski (1) , Didier Guillemot (1, 5) , Laurence Watier (1)

1 B2PHI - Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses
2 UP11 UFR Médecine - Université Paris-Sud - Paris 11 - Faculté de médecine
3 Centre coordinateur de l’Observatoire Régional des infections à Pneumocoque (ORP) [CHRU Tours]
4 Centre de Référence du Pneumocoque
5 Hôpital Raymond Poincaré [AP-HP]

Geographic variations of invasive pneumococcal disease incidence and serotype distributions were observed after pneumococcal conjugate vaccine introduction at regional levels and among French administrative areas. The variations could be related to regional vaccine coverage (VC) variations that might have direct consequences for vaccination-policy impact on invasive pneumococcal disease, particularly pneumococcal meningitis (PM) incidence. We assessed vaccine impact from 2001 to 2016 in France by estimating the contribution of regional VC differences to variations of annual local PM incidence. Using a mixed-effect Poisson model, we showed that, despite some variations of VC among administrative areas, vaccine impact on vaccine-serotype PM was homogeneously confirmed among administrative areas. Compared with the prevaccine era, the cumulative VC impact on vaccine serotypes led, in 2016, to PM reductions ranging among regions from 87% (25th percentile) to 91% (75th percentile) for 7-valent pneumococcal conjugate vaccine serotypes and from 58% to 63% for the 6 additional 13-valent pneumococcal conjugate vaccine serotypes. Nonvaccine-serotype PM increases from the prevaccine era ranged among areas from 98% to 127%. By taking into account the cumulative impact of growing VC and VC differences, our analyses confirmed high vaccine impact on vaccine-serotype PM case rates and suggest that VC variations cannot explain PM administrative area differences.

Mots clés: Bayesian inference; National Health Insurance data; administrative area variations; mixed-effect Poisson model; pneumococcal conjugate vaccine; pneumococcal meningitis; vaccine coverage

Domaines: Santé publique et épidémiologie; Vaccinologie

Anna Alari, Felix Cheysson, Lénaig Le Fouler, Philippe Lanotte, Emmanuelle Varon, et al.. Association of Pneumococcal Conjugate Vaccine Coverage With Pneumococcal Meningitis: An Analysis of French Administrative Areas, 2001–2016. American Journal of Epidemiology, 2019, 188 (8), pp.1466-1474. ⟨10.1093/aje/kwz071⟩. ⟨hal-02479128⟩