Pneumococcal vaccines: A dose of change. Vaccine failures and breakthrough infections in Belgian children during the PCV13 era (2019-2024)

作者：Dambre C, Cornelissen L, Cuypers L, Desmet S · 发表于：Vaccine · 年份：2026 · DOI：10.1016/j.vaccine.2025.128065 · 研究领域：Pneumococcal Vaccines、Pneumococcal Infections、Streptococcus pneumoniae、Humans、Belgium、Infant、Child, Preschool、Retrospective Studies、Male、Female、Serogroup、Infant, Newborn

BACKGROUND: Since 2019, PCV13 has replaced PCV10 in Belgium's childhood vaccination program, reducing IPD cases caused by PCV13 serotypes, mainly 19A, but accompanied by serotype replacement. This changing epidemiology prompted consideration of the higher-valent PCV20 vaccine. Despite broader serotype coverage, clinical effectiveness against certain serotypes remains uncertain, raising concerns about vaccine failures. To date, vaccine failures and breakthrough infections have not been systematically studied in Belgium. This study aims to establish a baseline by characterizing vaccine failures and breakthrough infections in children 0-5 years old during the recent PCV13 era, providing a reference point ahead of PCV20 introduction. METHODS: We conducted a retrospective cohort study including children ≤5 years diagnosed with IPD in Belgium from 2019 to 2024, using surveillance data from the National Reference Centre for invasive pneumococci and the PediSurv network. Vaccine failures and breakthrough infections were identified and characterized by serotype and clinical characteristics. RESULTS: Of 543 pediatric IPD cases with known vaccination status, 451 (83 %) had received at least one dose of pneumococcal conjugate vaccine. Among these, we identified 26 vaccine failures (5.8 %) and 37 breakthrough infections (8.2 %). Differences in breakthrough proportions between PCV10 and PCV13 were primarily driven by PCV13-exclusive serotypes, after adjustment no significant differences ...