• Jeffrey N Hanna, Jan L Humphreys, Denise M Murphy, and Helen V Smith.
• Tropical Regional Services, Queensland Health, Cairns, QLD, Australia. jeffrey_hanna@health.qld.gov.au
• Med. J. Aust. 2010 Oct 4; 193 (7): 392-6.

ObjectiveTo compare trends in invasive pneumococcal disease (IPD) in non-Indigenous people in north Queensland before and after the introduction of funded pneumococcal vaccines, and to examine the proportion of cases that occurred after vaccine roll-out that could be vaccine-preventable.Design, Setting And ParticipantsIn 2005, a 7-valent pneumococcal conjugate vaccine (7vPCV) for non-Indigenous children and a 23-valent pneumococcal polysaccharide vaccine (23vPPV) for non-Indigenous adults aged ≥ 65 years were made freely available. Trends in IPD in the non-Indigenous estimated resident population in north Queensland (about 581 850 in 2006) were compared between the 4 years before (2001-2004) and after (2006-2009) the vaccines were rolled out.Main Outcome MeasuresIncidences and serotypes of IPD in non-Indigenous people.ResultsAfter the introduction of the vaccines, there were significant declines for all ages in the average annual incidence of IPD (- 34%; P < 0.05) and 7vPCV serotype IPD (- 77%; P < 0.05). In children aged < 5 years, there was a 91% decline in the incidence of 7vPCV serotype IPD (P < 0.05); in adults aged 15-64 years and ≥ 65 years there were 62% and 77% declines, respectively, in 7vPCV and 23vPPV common-serotype IPD (P < 0.05). There was a 188% increase in 23vPPV-only serotype IPD in adults aged 15-64 years (P < 0.05), whereas there was no significant change in adults aged ≥ 65 years. Serotype 19A was the most frequently identified serotype in 2006-2009, causing 19% of all IPD in those 4 years.ConclusionsThere is circumstantial evidence that 7vPCV has had a powerful indirect effect in preventing IPD in adults in north Queensland; 23vPPV may have had a direct effect in adults aged ≥ 65 years. It is likely that with combined direct and indirect effects, newer conjugate vaccines could prevent more IPD than could be prevented with the two current vaccines.

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