Assessment of the appropriateness of an immunization program for pneumococcal infections in children using a reduced number of doses of conjugate vaccine
In Canada, the first 7-valent pneumococcal conjugate vaccine (PCV-7) was licenced in 2001. The manufacturer's recommendation is to administer three doses at an early age for primary immunization and a booster dose during the second year (Wyeth-Ayerst Canada Inc. 2001). The recommendation of the National Advisory Committee on Immunization (NAIC) is to give 3 doses of vaccines at the same time as the other vaccines provided in the schedule at the ages of 2, 4 and 6 months, and the booster dose between 12 and 15 months (NAIC 2002). An economic analysis done for Canada indicated that such a program would significantly reduce the burden of disease in children, but that the cost-effectiveness indices, established for a purchase price of $58 per dose, were not favorable compared to other immunization programs (De Wals et al. 2003). In 2002, in response to the report of the Working Group on Conjugate Antipneumococcal Vaccine (INSPQ 2003), the Quebec Immunization Committee (QIC) issued an opinion recommending introduction of this vaccine into the regular immunization program, indicating that the vaccine should be offered as a matter of priority to very premature infants, children under 5 years old suffering from chronic medical conditions associated with a high risk of infection, and children in Nunavik, where the incidence of pneumococcal disease is particularly high. This order of priorities has been followed and, at the present time, PCV-7 vaccine is being offered free of charge to children in the northern regions, premature infants and children who have a medical condition associated with a high risk of infection. Moreover, the vaccine is offered by the federal government to First Nations children living on reserves. A decision on the universality of this program must be taken soon in the context of a monopoly over marketing of the vaccine and a PCV-7 selling price on the order of $70 per dose. During the year 2004, the results of immunogenicity and clinical studies comparing schedules using a variable number of doses of conjugate pneumococcal vaccine were revealed; they permit assessment of immunization schedules using a smaller number of doses than had been advocated previously (INSPQ 2003).
Cette édition révisée remplace celle déposée sur le site Web en novembre 2004. Une erreur s'était glissée dans le premier document, page 35, dernier paragraphe, 2e ligne : on aurait dû lire 2,4 et 12 mois (et non 2,4,6, et 12).