1) The PSERENADE project analyzed surveillance data from over 50 sites in 34 countries to assess the impact of PCV10 and PCV13 introduction on pneumococcal meningitis incidence globally in children under 5 years old and adults 18 years and older. 2) For both age groups, PCV10 and PCV13 significantly reduced meningitis caused by serotypes covered by the vaccines, with almost elimination in children under 5 years old within 5 years. Herd protection was observed in adults as well. 3) PCV13 significantly reduced meningitis from additional serotypes it covers compared to PCV10, though serotype 19A increased with PCV10 and serotype 3 trends were unclear

1. Yangyupei Yang on behalf of the PSERENADE team*
November 2021
November 2021
1
Changes in Pneumococcal Meningitis Incidence
Following Introduction of PCV10 and PCV13:
Results from the Global PSERENADE Project
*The PSERENADE Team includes the Hopkins Core Team &
investigators in over 50 surveillance sites and at the WHO.

2. PSERENADE Project: Background & Methods
• Pneumococcal conjugate vaccines (PCV10 and PCV13)
have been introduced into infant immunization
programs of 147 countries
• We assessed the impact of PCV10/PCV13 introduction
on pneumococcal meningitis incidence globally in
children <5 years and adults ≥18 years
November, 2021
2
Number included in analysis:
Sites: PCV13 = 32 PCV10 = 14
Countries: PCV13 = 22 PCV10 = 12
N Cases: <5 years: 13,391 ≥18 years: 36,322
Methods
• Countries shared IPD surveillance data
• Meningitis cases = pneumococcus detected in cerebral
spinal fluid (CSF)
• Modeled each site’s change in meningitis incidence
after PCV introduction and averaged across sites
(Bayesian multi-level Poisson regression)
Stratified by: age group, PCV10 vs PCV13, and the
amount of PCV7 impact prior to PCV10/13
introduction
PCV not used
PCV used, data unavailable or ineligible for analysis
Included in PCV10 site analysis
Included in PCV13 site analysis
Mixed PCV10/13

3. Change in pneumococcal meningitis: PCV10 serotypes
CONFIDENTAL: Do Not Circulate
Children < 5 years Adults ≥ 18 years
PCV10/13
Intro
PCV10/13
Intro
Key messages: Meningitis caused by serotypes in PCV10 by year 5:
• <5 years -- Almost eliminated in most sites
• ≥18 years – large herd effect but took longer and heterogeneous across sites
Incidence
Rate
Ratio
79-99%
declines
Year since PCV10/13 introduction
74-99%
declines
44-92%
declines
43-74%
declines
November, 2021
1.0=Pre-PCV Rate
Serotypes
1,
5,
and
7F
PCV7
Serotypes

4. Change in pneumococcal meningitis: PCV13 (non-10) Types
Incidence
Rate
Ratio
Year since PCV10/13 introduction
Children < 5 years Adults ≥ 18 years
PCV10/13
Intro
PCV10/13
Intro
48-96% decline
80-99% decline
PCV13: 78-93%
decline
PCV10: 4-9 fold
increase
Key messages
•Evidence of cross
protection against 6A for
PCV10
•19A was reduced at
PCV13 sites, but
increased at PCV10 sites
•No clear trends in
Serotype 3 for either
product
PCV10: 5-8 fold
increase
PCV13: 10-53%
decline
November, 2021
Serotype
3
Serotype
19A
Serotype
6A

5. Change in pneumococcal meningitis: Non-PCV13 Types
5
Incidence
Rate
Ratio
Year since PCV10/13 introduction
Children < 5 years Adults ≥ 18 years
2.2-3.2 fold
increase
PCV10/13
Intro
PCV10/13
Intro
N=1 N=1
1.3-2.3 fold
increase
November, 2021
A single high HIV-prevalence site
with concurrent non-vaccine
interventions, including ART
Key messages
Non-PCV13 serotypes:
• Increased in both age groups; both PCV10 and PCV13
• Increase peaked by year 5

6. Change in all pneumococcal meningitis
6
Year since PCV10/13 introduction
Key messages
For both PCV10 and PCV13 sites, the net impact on all
pneumococcal meningitis by year 5 was a reduction in all ages:
• children <5 years – reduced about 50-70%
• Adults ≥18y years – reduced by about 25-36% (most sites)
Incidence
Rate
Ratio
PCV10/13
Intro
1.0=Pre-PCV Rate
52-71% decline
Children < 5 years Adults ≥ 18 years
PCV10/13
Intro
8-36% decline
November, 2021