Exploring the acceptability of the available pneumococcal conjugate vaccines in Canadian health care professionals and immunization experts

Abstract

Background

In children, the 13 and 10-valent pneumoccocal conjugate vaccines (PCV13/10) are currently approved for the prevention of invasive pneumococcal disease (IPD). Acceptability is a key consideration in the implementation of a vaccine program and it is recognized that health professional’s attitudes and opinions towards vaccines are independent predictors of the success of an immunization program. We aimed to survey the beliefs and attitudes for the two available PCVs in health care professionals and immunization experts.

Findings

We interviewed 21 members of Canadian immunization committees and/or participants working in frontline healthcare delivery. Overall, participants predominantly preferred PCV-13 over PCV10. For most, AOM should not be taken into considerations in decisions for pneumococcal vaccination programs implementation. AOM was considered an important endpoint of the program but an ineffective measure of program success due to the lack of surveillance for the condition. Recent evidence pertaining to PCV10 cross-protection against 19A did not affect preference but had an impact on perceptions regarding pricing.

Conclusion

To consider implementing any changes to the current program, most participants would require more evidence regarding PCV10 cross-protection and effectiveness against OM. Decreasing vaccine price was cited as a positive outcome of funding both vaccines.

Introduction

Streptococcus pneumoniae is a bacterial pathogen that can cause invasive pneumococcal disease (IPD) such as meningitis, bacteremia and sepsis, as well as less severe non-invasive diseases, such as pneumonia and acute otitis media (AOM) [1]. Non-typeable Haemophilus influenzae (NTHi) strains are recognized as causal pathogens in non-invasive mucosal diseases, such as AOM and sinusitis. In Quebec, it has been estimated that otitis media in children younger than 10 years of age accounts for approximately 11% of physicians’ billings claims [2].

PCV7 was licenced in Canada in 2001 and, as of 2006, used in infant vaccination programs across all provinces and territories [3]. However, within a few years of the program’s implementation, serotype replacement threatened to offset the benefits afforded by the vaccine [4]. Consequently, higher valent vaccines were introduced. The PCV10 vaccine became available in 2009 and implemented in some provinces, employing a novel carrier protein derived from NTHi and offering protection for all serotypes included in PCV7 plus an additional three serotypes: 1, 5A and 7F [5]. It has been argued that the NTHi-derived carrier protein would afford additional protection against AOM and other diseases caused by NTHis [5], [6]. PCV13 was introduced in 2010, offering protection for all serotypes included in PCV10 and three additional serotypes: 3, 6A and 19A [7]. The inclusion of 19A, a serotype with high invasive potential and associated burden of disease, led most provinces and territories to preferentially choose PCV13 over PCV10 for their infant immunization programs [8]. However, emerging findings suggest a level of cross-protection against 19A from the 19F serotype contained in PCV10 [9], [10], [11]. In light of these findings, Health Canada has amended their indications for PCV10, acknowledging the cross-protection against 19A in an updated product monograph [12]. This evidence, in addition to the suggested increased protection against NTHi-related diseases afforded by PCV10, will have considerable implications for upcoming assessments of how these vaccine options compare in terms of benefits per amount of dollars spent.

In Erickson, De Wals and Farand’s (2011) analytical framework for making decisions concerning immunization programs in Canada [13], acceptability is identified as a marker of desirability concerning a given product and a powerful driver of program implementation. Health professionals are often the most trusted source of information concerning vaccines and as such play a pivotal role in recommending and enhancing vaccine uptake [14]. To date, information is lacking on frontline healthcare workers and immunization experts’ perceptions of the higher valent pneumococcal vaccines. We aimed to assess the perceptions of frontline healthcare workers and immunization experts on whether PCV10 is considered an acceptable alternative to PCV13, as well as factors offered in support of their opinions. This information will aid in recognizing knowledge gaps pertaining to the evidence in support for each vaccine, and in putting forth national guidelines that are acceptable and endorsed by healthcare workers, therefore achieving nationwide uptake and optimal immunization results.