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Background: To aid decision making for pneumococcal conjugate vaccine (PCV) use in infant national immunization programs, we summarized the indirect effects of PCV on clinical outcomes among nontargeted age groups.

Methods: We systematically reviewed the English literature on infant PCV dosing schedules published from 1994 to 2010 (with ad hoc addition of 2011 articles) for outcomes on children >5 years of age and adults including vaccine-type nasopharyngeal carriage (VT-NP), vaccine-type invasive pneumococcal disease (VT-IPD) and syndromic pneumonia.

Results: Of 12,980 citations reviewed, we identified 21 VT-IPD, 6 VT-NP and 9 pneumonia studies. Of these 36, 21 (58%) included 3 primary doses plus PCV or pneumococcal polysaccharide vaccine (PPV23) booster schedule (3 1 or 3 PPV23), 5 (14%) 3 0, 9 (25%) 2 1 and 1 (3%) 2 0. Most (95%) were PCV7 studies. Among observational VT-IPD studies, all schedules (2 1, 3 0 and 3 1) demonstrated reductions in incidence among young adult groups. Among syndromic pneumonia observational studies (2 1, 3 0 and 3 1), only 3 1 schedules showed significant indirect impact. Of 2 VT-NP controlled trials (3 0 and 3 1) and 3 VT-NP observational studies (2 1, 3 1 and 3 PPV23), 3 1 and 3 PPV23 schedules showed significant indirect effect. The 1 study to directly compare between schedules was a VT-NP study (2 0 vs. 2 1), which found no indirect effect on older siblings and parents of vaccinated children with either schedule.

Conclusions: Indirect benefit of a 3 1 infant PCV dosing schedule has been demonstrated for VT-IPD, VT-NP and syndromic pneumonia; 2 1 and 3 0 schedules have demonstrated indirect effect only for VT-IPD. The choice of optimal infant PCV schedule is limited by data paucity on indirect effects, especially a lack of head-to-head studies and studies of PCV10 and PCV13.

(C) 2014 by Lippincott Williams & Wilkins, Inc.