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Volume 18, Number 11—November 2012


Invasive Pneumococcal Disease and 7-Valent Pneumococcal Conjugate Vaccine, the Netherlands

Anna M.M. van Deursen1, Suzan P. van Mens1, Elisabeth A.M. Sanders, Bart J.M. Vlaminckx, Hester E. de Melker, Leo M. Schouls, Sabine C. de Greeff2, Arie van der Ende2Comments to Author , and on behalf of the Invasive Pneumococcal Disease Sentinel Surveillance Laboratory Group
Author affiliations: University Medical Center, Utrecht, the Netherlands (A.M.M. van Deursen, S.P. van Mens, E.A.M. Sanders); Linnaeus Institute, Hoofddorp, the Netherlands (A.M.M. van Deursen); St Antonius Hospital, Nieuwegein, the Netherlands (S.P. van Mens, B.J.M. Vlaminckx); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (H.E. de Melker, L.M. Schouls, S.C. de Greeff); Academic Medical Center, Amsterdam, the Netherlands (A. van der Ende); Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam (A. van der Ende)

Main Article

Table 4

Proportion of vaccine-type and nonvaccine type invasive pneumococcal disease cases before and after implementation of a PCV7 vaccination program, the Netherlands, June 2004–May 2010*

Vaccination period, infecting serotype No. (%) patients, by health status at time of infection
Otherwise healthy Immunocompromising
condition† p value Any comorbidity‡ p value
Pre-implementation period

Total no. cases

399 216 NA 817 NA

PCV7 cases

189 (47) 88 (41) NS 376 (46) NS

Non–PCV7 cases

209 (52) 128 (59) NS 441 (54) NS
Post-implementation period

Total no. cases

356 255 NA 788 NA

PCV7 cases

78 (22) 73 (29) NS 190 (24) NS

Non–PCV7 cases

278 (78) 182 (71) 0.050 598 (76) NS

*Cases are number of patients included in a study covering ≈25% of the Dutch population. Pre-implementations period, June 2004–May 2006; post-implementation period, June 2008–May 2010. Boldface, significant difference (p<0.05, calculated by χ2 test) compared with otherwise healthy patients. PCV7, 7-valent pneumococcal conjugate vaccine; NA, not applicable; NS, not significant (p>0.05).
†Immunocompromising condition: primary immunodeficiency, HIV/AIDS, lymphoma, leukemia, myeloma, solid organ or stem cell transplant, current immunosuppressive therapy for malignancy or autoimmune disease, asplenia/splenectomy, sickle cell disease, and renal insufficiency (dialysis required and nephrotic syndrome).
‡Any comorbidity: malignancies (within previous 5 y) not considered to be immunocompromising; chronic pulmonary disease (chronic obstructive pulmonary disease and asthma); diabetes mellitus; cardiovascular disease (myocardial infarction, coronary artery condition, stroke/transient ischemic attack, cardiomyopathy, heart failure, heart valve disease, and presence of cerebral/abdominal/thoracic aneurysms); thyroid disease; liver disease; intravenous drug use; long-term alcohol abuse; cerebrospinal fluid leak; recent physical trauma/skull fracture; and, for children, premature birth (<37 weeks for children 0–1 y old and <32 weeks for children 0–4 y old).

Main Article

1These authors contributed equally to this article.

2These authors contributed equally to this article.

3Additional members of the Invasive Pneumococcal Disease Sentinel Surveillance Laboratory Group are listed at the end of this article.

Members of the Invasive Pneumococcal Disease Sentinel Surveillance Laboratory Group: Karola Waar, Izore, Centre for Infectious Diseases Friesland, Leeuwarden, the Netherlands; Bert Mulder, Laboratory of Medical Microbiology Twente Achterhoek, Enschede, the Netherlands; Caroline Swanink, Department of Medical Microbiology and Medical Immunology Hospital Rijnstate, Arnhem, the Netherlands; Bram Diederen, Regional Laboratory of Public Health, Haarlem, the Netherlands; Niek Arents, Laboratory for Pathology and Medical Microbiology, Veldhoven, the Netherlands; Ine Frénay, Regional Laboratory for Medical Microbiology and Infectious Diseases, Dordrecht–Gorinchem, the Netherlands; Hans Wagenvoort, Atrium Medical Center, Heerlen, the Netherlands; Bartelt de Jongh, St. Antonius Hospital, Nieuwegein, the Netherlands; Lodewijk Spanjaard, Academic Medical Center, Amsterdam, the Netherlands