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Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children

BLACK, STEVEN MD; SHINEFIELD, HENRY MD; FIREMAN, BRUCE MA; LEWIS, EDWIN MPH; RAY, PAULA MPH; HANSEN, JOHN R. BA; ELVIN, LAURA; ENSOR, KATHY M. RN; HACKELL, JILL MD; SIBER, GEORGE MD; MALINOSKI, FRANK MD, PhD; MADORE, DACE PhD; CHANG, IH PhD; KOHBERGER, ROBERT PhD; WATSON, WENDY MD; AUSTRIAN, ROBERT MD; EDWARDS, KATHY MD; THE NORTHERN CALIFORNIA KAISER PERMANENTE VACCINE STUDY CENTER GROUP

Pediatric Infectious Disease Journal:
Original Studies
Abstract

Objective. To determine the efficacy, safety and immunogenicity of the heptavalent CRM197 pneumococcal conjugate vaccine against invasive disease caused by vaccine serotypes and to determine the effectiveness of this vaccine against clinical episodes of otitis media.

Methods. The Wyeth Lederle Heptavalent CRM197 (PCV) was given to infants at 2, 4, 6 and 12 to 15 months of age in a double blind trial; 37 868 children were randomly assigned 1:1 to receive either the pneumococcal conjugate vaccine or meningococcus type C CRM197 conjugate. The primary study outcome was invasive disease caused by vaccine serotype. Other outcomes included overall impact on invasive disease regardless of serotype, effectiveness against clinical otitis media visits and episodes, impact against frequent and severe otitis media and ventilatory tube placement. In addition the serotype-specific efficacy against otitis media was estimated in an analysis of spontaneously draining ears.

Results. In the interim analysis in August, 1998, 17 of the 17 cases of invasive disease caused by vaccine serotype in fully vaccinated children and 5 of 5 of partially vaccinated cases occurred in the control group for a vaccine efficacy of 100%. Blinded case ascertainment was continued until April, 1999. As of that time 40 fully vaccinated cases of invasive disease caused by vaccine serotype had been identified, all but 1 in controls for an efficacy of 97.4% (95% confidence interval, 82.7 to 99.9%), and 52 cases, all but 3 in controls in the intent-to-treat analysis for an efficacy of 93.9% (95% confidence interval, 79.6 to 98.5%). There was no evidence of any increase of disease caused by nonvaccine serotypes. Efficacy for otitis media against visits, episodes, frequent otitis and ventilatory tube placement was 8.9, 7.0, 9.3 and 20.1% with P < 0.04 for all. In the analysis of spontaneously draining ears, serotype-specific effectiveness was 66.7%.

Conclusion. This heptavalent pneumococcal conjugate appears to be highly effective in preventing invasive disease in young children and to have a significant impact on otitis media.

Author Information

From the Kaiser Permanente Vaccine Study Center, Oakland, CA (SB, HS, BF, EL, PR, JRH, LE, KME); Wyeth Lederle Vaccines and Pediatrics, Pearl River, NY (JH, GS, FM, DM, IC, RK, WW); University of Pennsylvania, School of Medicine, Philadelphia, PA (RA); and Vanderbilt University Medical Center, Nashville, TN (KE).

Address for reprints: Steve Black, M.D., Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, Oakland, CA 94612. Fax 510-267-7524; E-mail Steve.Black@@kp.org.

Accepted for publication Dec. 20, 1999.

*Members of the Northern California Kaiser Permanente Vaccine Study Center Group: Drs. Janet Aguilar, Marissa Bartlett, Randy Bergen, Mel Burman, Steve Dorfman, Wayne Easter, Annette Finkel, Hervey Froehlich, James Glauber, Arnd Herz, David Honeychurch, Robert Kleinrock, Irene Landaw, Allan Lavetter, Chinh Le, Steve McMurtry, Pius Morozumi, Pat Mullin, Michael Rehbein, Richard Rossin, Garwin Soe, Irene Takahashi, Gail Udkow, Robert Whitson. %Key words: Heptavalent pneumococcal conjugate vaccine, efficacy, safety, immunogenicity.

© 2000 Lippincott Williams & Wilkins, Inc.