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BACKGROUND: Streptococcus pneumoniae causes morbidity and mortality among all ages in The Netherlands. To reduce this burden, infants in The Netherlands receive the 10-valent pneumococcal conjugated vaccine (PCV10), but older persons are not targeted. We assessed the impact and cost-effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23) or 13-valent PCV (PCV13) among all those aged 60, 65 or 70 and/or in combination with replacing PCV10 with PCV13 in the infant vaccination programme.METHODS: A static cost-effectiveness model was parameterized including projected trends for invasive pneumococcal disease (IPD) and hospitalised community acquired pneumonia (CAP). The different strategies were evaluated using vaccine list prices and a 10-year time horizon. Incremental cost-effectiveness ratios (ICER) were calculated with the current strategy (infant vaccination program with PCV10) as reference.RESULTS: Compared to the reference, the largest impact on pneumococcal disease burden was projected with a combined use of PCV13 among infants and PPV23 at 60, 65 and 70 years, preventing 1,635 cases of IPD and 914 cases of CAP. The most cost-effective strategy was vaccinating with PPV23 at 70 years only with similar low ICERs at age 60 and 65. The impact of the use of PCV13 among infants depends strongly on the projected herd-immunity effect on serotype 19A. Vaccinating elderly with either PCV13 or PPV23 was dominated by PPV23 in all investigated scenarios, mainly due to the lower price of PPV23.CONCLUSION: Under the current assumptions, the best value for money is the use of PPV23 for elderly, with a single dose or at five year increment between age 60 to age 70.

A phase 1-2 trial was conducted in 48 adults to study safety and immunogenicity of an inactivated poliovirus vaccine produced using Vero cells (IPV-Vero). Participants received 2 intramuscular injections with IPV-Vero (40-8-32 D-Ag units) 4 weeks apart. IPV-Vero was well tolerated, and induced strong antibody responses in all participants. At least an 8-fold titre rise against all 3 types of poliovirus was found within 1 week of the first vaccination, indicating a strong secondary response in primed individuals. Two days after the first vaccination, there was no indication for such a booster reaction. The second vaccination 4 weeks after the first dose did not further increase antibody levels, indicating that an immune plateau had been achieved after the first vaccination. The second vaccination was not reactogenic despite the presence of these high pre-vaccination antibody levels. We conclude that IPV-Vero is well tolerated and strongly immunogenic in adults. In pre-immune adults 1 dose is enough to induce an impressive booster reaction.

Conventional hepatitis B vaccines do not elicit adequate antibody production in 5-10% vaccinees. This trial tests the ability of a third-generation vaccine, containing PreS1 and PreS2 antigens in addition to the S antigen, to elicit seroprotective titres in documented non- and low-responders, compared with those to a conventional vaccine. In the primary population of non-responders (10 IU/l anti-HBs antibodies afteror = 4 previous injections of conventional vaccine) an enhanced antibody response was seen to additional injections of the third-generation vaccine compared with a conventional vaccine (absolute difference 14.9%; P = 0.006). Enhanced antibody responses were also found in a population that included low responders.