streptococcus pneumoniae<\/em>. The program began with PCV7 (containing antigens from seven PCV serotypes), which was later upgraded to PCV13, targeting 13 serotypes.<\/p>\nThe new PCV schedule replaced two primary doses and a booster dose (at 8 and 16 weeks and 12 months, respectively) with a primary dose at 12 weeks and a booster dose at 12 months. These are called 2+1 and 1+1 schedules respectively. To date, the UK is the only European country with this schedule.<\/p>\n
While earlier immunogenicity studies suggested broadly comparable protection, the latter depends on its success in timely booster reception. However, interpretation of subsequent patterns of change is complicated by the pandemic-related reduction in infectious disease transmission during the coronavirus disease 2019 (COVID-19) period.<\/p>\n
Persistent vaccine-type pneumococcal disease<\/h2>\n
In England, stable, low vaccine-type (VT) IPD rates were observed in all age groups within 4 years after the introduction of both vaccines. In contrast, global trends show that VT IPD rates in the under-five age group decreased and then stabilized seven years after the introduction of PCV13. The infection rate in people older than this continued to decline for nine years.<\/p>\n
Despite these benefits, VT IPD persists, underscoring the need for effective prevention.<\/p>\n
<\/p>\n
booster gap widens<\/h2>\n
Pediatric vaccinations have declined across England since 2019. According to this, national PCV booster coverage at 24 months reached 92.5% in 2012-13, but fell to 88.2% in 2023-24. For reference, the World Health Organization (WHO) target is 95%.<\/p>\n
Uptake of the primary PCV dose before 2020 was 93.2%, but booster coverage at 24 months was 91.2%. Thus, with the 2+1 schedule, the average difference was 2.32%, which increased to 4.79% under the revised schedule.<\/p>\n
While this coincides with a pandemic-related decline in vaccine coverage, the study said it may reflect broader changes in both vaccination patterns and pandemic-related disruptions, rather than changes in schedules alone.<\/p>\n
At the local authority level, about 42% reported 95% coverage over 12 months under any schedule. With the 2+1 schedule, only 23.3% achieved 95% coverage at 24 months. With the revised program this fell to 10.7%, with the overall average of local authorities meeting the target at 17.8%.<\/p>\n
deprivation inequalities<\/h2>\n
This had an adverse impact on disadvantaged groups. Based on deprivation index data, the gap in PCV booster coverage between the least and most deprived quintiles increased from 2-3% before 2020 to 4-6%. In a separate analysis of primary and booster coverage in London (due to its distinct demographic profile compared to the rest of England), the city showed a very low booster retention rate.<\/p>\n
Before the adoption of the revised schedule, booster coverage in some local authorities exceeded primary dose uptake, possibly reflecting catch-up vaccination or reporting variation. After 2020, booster coverage declined in many parts of London, with a decline in Hackney, at 65.5%.<\/p>\n
Burden of IPD in disadvantaged populations<\/h2>\n
The incidence of IPD was 7 per 100,000 people among the least deprived, compared to 13.6 per 100,000 among the most deprived, indicating a greater burden among the socially deprived.<\/p>\n
With low booster uptake rates, model-based estimates suggest higher susceptibility to VT IPD in recent cohorts, particularly in deprived areas. This ranged from 22.4% to 47.8%, compared to the lowest in the most deprived local authorities.<\/p>\n
PCVs with higher valence may have less ability to prevent carriage due to lower immunogenicity, and thus may not prevent asymptomatic carrier state. Together, these effects may reduce herd immunity.<\/p>\n
Limitations of the study<\/h2>\n
The study used deprivation measures covering neighborhoods covering a wide range of socio-economic status. They may overlook severely deprived areas within more affluent areas, as is the case in many London boroughs, or vice versa.<\/p>\n
Estimates of vaccine effectiveness for the 1+1 schedule have yet to be fully validated, and therefore European studies based on the earlier schedule were used to calculate sensitivity. Catch-up vaccination was not taken into account, and the impact of the pandemic on vaccine coverage may be confounded by the new schedule.<\/p>\n
As with ecological analyses, studies cannot establish individual-level causality and may be influenced by area-level confounding factors such as ethnicity, health status, and other demographic variables.<\/p>\n
Implications for health policy<\/h2>\n
The revised PCV schedule may risk reducing the impact of the program if high and equitable booster uptake is not maintained. Ensuring universal booster uptake is an important component of the programme. Furthermore, the growing gap in booster coverage between the rich and the poor may contribute to higher and more unequal VT IPD burden in the community.<\/p>\n
\u201cThe success of the 1+1 schedule depends on maintaining equitable, high booster uptake.\u201d There is a need for focused support and establishment of better follow-up systems in these areas.<\/p>\n
Download your PDF copy by clicking here.<\/a><\/p>\n<\/p><\/div>\n","protected":false},"excerpt":{"rendered":"A major overhaul of England’s childhood vaccination strategy is exposing unexpected gaps in protection, with a decline in booster take-up and rising inequality potentially putting the most vulnerable children at greater risk of serious infections. Study: Disparities in childhood pneumococcal conjugate vaccine uptake in England before and after the change from a 2+1 to 1+1<\/p>\n","protected":false},"author":1,"featured_media":46219,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[60],"tags":[17339,2502,9562,4184,5394,17340,4375],"class_list":["post-46216","post","type-post","status-publish","format-standard","has-post-thumbnail","category-meditation","tag-booster","tag-change","tag-declines","tag-england","tag-schedule","tag-uptake","tag-vaccine"],"_links":{"self":[{"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/posts\/46216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/comments?post=46216"}],"version-history":[{"count":1,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/posts\/46216\/revisions"}],"predecessor-version":[{"id":46220,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/posts\/46216\/revisions\/46220"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/media\/46219"}],"wp:attachment":[{"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/media?parent=46216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/categories?post=46216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/christiancorner.us\/index.php\/wp-json\/wp\/v2\/tags?post=46216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}