Steens, Ade Boer, PTRots, NYSanders, EAde Melker, HE2024-12-172024-12-172024-12-1710.21945/RIVM-2024-0181https://rivm.openrepository.com/handle/10029/627917Pneumococci cause severe infections, such as pneumonia, septicaemia and meningitis. Severe (invasive) pneumococcal disease is diagnosed among children under 5 years old approximately 75 times a year. About 5% of those children die from the infection. To prevent pneumococcal disease as much as possible, children are immunised against pneumococci through the national childhood immunisation programme (NIP). Since autumn 2024, a vaccine has been used that induces antibodies against more pneumococcal types than previously (15 instead of 10 - PCV15), called a higher-valent vaccine. Since 2024, a vaccine inducing antibodies against 20 types has become available (PCV20). Both vaccines have been tested extensively. However, no data is currently available on effectiveness in practice. The Ministry of Health, Welfare and Sport has requested the Health Council to advise on the use of PCV20. To this end, RIVM has collected background information. The information includes data on the occurrence of severe pneumococcal disease in children and other age groups, including older adults. It also shows the disease-causing pneumococcal types; there are many different types. Furthermore, it describes which pneumococcal vaccines are available, as well as the safety of these vaccines, how they act and how often they are offered in the NIP. Currently, children are offered PCV15 at the ages of 3, 5 and 12 months in the NIP. The vaccineregistration agency has licensed PCV20 in a four-dose regime. Pneumococcal vaccines do not only prevent vaccinated children from becoming ill. They also reduce the spread of pneumococci from children to others, providing indirect protection of their surroundings. It is, however, still possible that types against which the vaccine does not protect will spread more after introduction of the vaccine. These types can cause disease - this is called serotype replacement. RIVM has estimated how much it would cost and how many cases could be prevented if children were offered PCV20 instead of PCV15. The fact that older adults will be offered PCV20 from 2025 onwards has been taken into account. It is estimated that using PCV20 in children would result in slightly fewer children becoming ill. However, the costs are high compared to the health gains. Additionally, more older adults may become ill if children were to use PCV20 instead of PCV15. Because of serotype replacement, more individuals could then become ill from serotypes not covered by PCV20.application/pdfenRIVM rapport 2024-0181Report2024-12-17