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Vaccinated infants well protected against severe pneumococcal infection in Norway

July 10, 2008

In 2006, a pneumococcal vaccine (Prevenar®) was introduced in the childhood vaccination programme in Norway. Two years later, the experiences have been published in the journal Vaccine. The results show a strong decline in serious pneumococcal infections among young children.

Pneumococcus is a bacterium that can cause serious illnesses in some young children, e.g. meningitis, blood poisoning and pneumonia. Most of those who become ill are previously healthy without any known predisposing factors. The bacterium is present in the nose of up to 80 - 90% of healthy young children.
A growing problem

A major reason for the introduction of the pneumococcal vaccine in the childhood vaccination programme was a steady increase in the number of cases of severe pneumococcal infection among young children in Norway. The vaccine protects against seven serotypes of pneumococcus which account for 70% of the serious cases of the disease.
Good effect with no vaccine failures

- Having summed up the experience gained from the first two years after introducing the vaccine, the results confirm that it works as well as intended," says Marianne R. Bergsaker, senior medical officer at the Norwegian Institute of Public Health and co-author of the article in Vaccine.

- Among all children under two years, in the first two years after the introduction of the vaccine there was a 70 % decline of serious pneumococcal infections caused by the targeted serotypes, compared with pre-introduction figures," she says.
Of the children who received at least two vaccine doses, none have had serious pneumococcal infections.

- We have so far failed to find an example of what is called vaccine failure for children who have received two or more vaccine doses," says Bergsaker.
Practical details

In Norway, the vaccine is administered at 3, 5 and 12 months of age, i.e. a 3-dose programme. In most other countries, giving four doses of vaccine is common.

- Our experience shows that a three-dose programme is sufficient to give the children good protection. A three-dose programme is also advantageous because the vaccine can be administered at the same time as other vaccines in the Norwegian childhood vaccination programme. This makes it easier for both parents and the health services.
Good support from the beginning
In the first year there was already high accept of the vaccine. Of the children who were offered the vaccine in 2006, 95% had at least one dose, 90% received two doses and 80% had all three doses.

Have there been any unexpected events or adverse effects from the vaccine?

- We have not seen any unexpected serious reactions or permanent damage caused by the pneumococcal vaccine. Generally, the most common reactions to vaccines in children are tenderness at the injection site, a light fever and a general feeling of unwell. Feedback indicates that the pneumococcal vaccine causes immediate pain at the injection site and high fever somewhat more frequently than other childhood vaccines. The health clinic gives parents information on how to deal with such relatively common reactions to vaccines, says Bergsaker.

The Vaccine-article pointed out that so far an increase of the other pneumococcus serotypes has not been seen. What does this mean?

- After the introduction of the vaccine, we have seen a reduced incidence of the serotypes that the vaccine targets in children under two years of age. So far, we have not seen any other serotypes increasing and "taking over". This is something we will continue to monitor, says Bergsaker.

Norwegian Institute of Public Health