Dynamics of Invasive Pneumococcal Disease in Israel in Children and Adults in the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Era: A Nationwide Prospective Surveillance

Shalom Ben-Shimol, Gili Regev-Yochay, Noga Givon-Lavi, Bart Adriaan Van Der Beek, Tal Brosh-Nissimov, Avi Peretz, Orli Megged, Ron Dagan, Jacob Amir, Galia Barkai, Diana Averbuch, Shraga Aviner, Ahuva Bachinski, Maskit Bar-Meir, Avihu Bar-Yochai, Ilana Benedikt, Rita Bernstein, Tal Brosh-Nissimov, Nael Elias, Dan EngelhardMoshe Ephros, Daniel Glikman, Giora Gottesman, Galia Grisaru-Soen, Alex Guri, Imad Kasis, Nathan Keller, Zina Korenman, Amir Asher Kuperman, Orli Megged, Dan Miron, Meirav Mor, Hana Ofir-Mintzer, Uri Rubinstein, Yechiel Schlesinger, David Schwartz, Itamar Shalit, Eli Somekh, Isaac Srugo, Alvira Zbriger, Miriam Zucker, Gili Regev-Yochay, Marc Assous, Haim Ben-Zvi, Jihad Bishara, Rita Bardenstein, Larissa Brik, Bibiana Chazan, Michal Chowers, Ronit Cohen-Poradosu, Talia Finn, Alicia Embon, Sarit Freimann, Yuval Geffen, Danny Glikman, Mirit Hershman, Valery Istomin, Michal Katzir, Yoram Kennes, Shirley Khakshoor, Camellia Khoury-Assi, Mandelbaum Sari, Yasmin Maor, Danny Miron, Ilana Oren, Yosi Paitan, Yael Paran, Israel Potasman, Galia Rahav, Hagai Rechnitzer, Klaris Reisenberg, Shifra Sela, David Schwartz, Orna Schwartz, Pninit Shaked-Mishan, Yehudit Sheindler, Gill Smollan, Itzhak Srugo, Michal Stein, Jacob Strahilevitz, Olga Sverdlob, Violetta Temper, Yonit Viener-Well, Gabriel Weber, Miriam Weinberger, Oren Zimchony, Yevgenia Ztibba

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13 Scopus citations


Background: Following 13-valent pneumococcal conjugate vaccine (PCV13) implementation in infants worldwide, overall and vaccine-type invasive pneumococcal disease (IPD) rates declined in children, with variable indirect impact on adults. Methods: A population-based, prospective, nationwide active surveillance of IPD in Israel, 2004-2019 (for adults ≥18 years, 2009-2019). The 7-valent PCV (PCV7)/PCV13 were implemented in Israel in July 2009/November 2010, respectively, with >90% uptake in children <2 years. The 23-valent pneumococcal polysaccharide vaccine (PPV-23) uptake among those >65 years was ~75%. For pre-PCV episodes with missing serotype, extrapolations were applied. Overall, PCV13 serotypes (VT13) and non-VT13 (NVT) incidence rate ratios (IRRs) comparing pre-PCV (2004-2008), early-PCV (2009-2011), and late-PCV13 (2016-2019) periods were calculated for different age groups. Results: Overall, 8614 IPD cases were recorded. IPD rates declined by 67% in children <5 and 5-17 years, comparing late-PCV13 versus pre-PCV periods (IRR [95% CI]:. 33 [.27-.40] and. 33 [.21-.50], respectively). For adults, comparing late-PCV13 with early-PCV periods, rates significantly declined by 53% in those aged 18-44, while rates did not decline significantly in other age groups. VT13 rates significantly declined in all ages, with decline rates ranging between 94% in children <5 years and 60% in adults ≥85 years. NVT rates significantly increased in <5-, 50-64-, and ≥65-year age groups. In the late-PCV13 period, serotypes 3, 14, and 19A remained the predominant VT13, while serotypes 8 and 12F emerged as predominant NVTs. Conclusions: Continuous monitoring of circulating serotypes in all ages demonstrated direct and indirect PCV effects, which are essential for the development of new vaccination strategies.

Original languageEnglish
Pages (from-to)1639-1649
Number of pages11
JournalClinical Infectious Diseases
Issue number9
StatePublished - 3 May 2022

Bibliographical note

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.


  • Israel epidemiology
  • indirect protection
  • invasive pneumococcal disease
  • pneumococcal conjugate vaccines


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