Streptococcus pneumoniae (the pneumococcus) is a common nasopharyngeal commensal that can cause invasive pneumococcal disease (IPD). Each component of current protein–polysaccharide conjugate vaccines (PCVs) generally induces immunity specific to one of the approximately 100 pneumococcal serotypes, and typically eliminates it from carriage and IPD through herd immunity. Overall carriage rates remain stable owing to replacement by non-PCV serotypes. Consequently, the net change in IPD incidence is determined by the relative invasiveness of the pre- and post-PCV-carried pneumococcal populations. In the present study, we identified PCVs expected to minimize the post-vaccine IPD burden by applying Bayesian optimization to an ecological model of serotype replacement that integrated epidemiological and genomic data. We compared optimal formulations for reducing infant-only or population-wide IPD, and identified potential benefits to including non-conserved pneumococcal carrier proteins. Vaccines were also devised to minimize IPD resistant to antibiotic treatment, despite the ecological model assuming that resistance levels in the carried population would be preserved. We found that expanding infant-administered PCV valency is likely to result in diminishing returns, and that complementary pairs of infant- and adult-administered vaccines could be a superior strategy. PCV performance was highly dependent on the circulating pneumococcal population, further highlighting the advantages of a diversity of anti-pneumococcal vaccination strategies.
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The original sequence datasets underlying this analysis are in the public sequence databases with the accession codes given in Supplementary Dataset 3 of Corander et al.12. The epidemiological and phylogenetic data are available at https://microreact.org/project/multilocusNFDS. The input matrix G, the serotype for each isolate, the equilibrium frequencies for each locus and other input data are available from https://github.com/carolinecolijn/optimvaccine.
The model code is available at https://github.com/carolinecolijn/optimvaccine.
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We thank C. Levy for sharing epidemiological data. C.C. was supported by the Engineering and Physical Sciences Research Council of the United Kingdom (grant nos. EP/K026003/1 and EP/N014529/1) and the Government of Canada’s Canada 150 Research Chair programme. J.C. was supported by European Research Council grant no. 742158. N.J.C. was supported by a Sir Henry Dale Fellowship, jointly funded by Wellcome and the Royal Society (grant no. 104169/Z/14/A), and by the UK Medical Research Council and Department for International Development (grant no. MR/R015600/1).
C.C. and N.J.C. have protected the formulations identified in this work. N.J.C. has consulted for Antigen Discovery Inc. and been awarded an investigator-initiated award by GlaxoSmithKline.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Comparison of the Massachusetts and Maela populations. a, Frequencies of serotypes across the two studied populations; serotypes 15B and 15C, which rapidly interchange but were resolved separately in the Maela dataset, are merged into 15B/C for comparability in this plot. b, Frequencies of sequence clusters, groupings analogous to strains defined by Corander et al, across the two populations. Both plots demonstrate the dissimilarity of these two S. pneumoniae populations, despite them being isolated from nasopharyngeal carriage almost contemporaneously. c, Distribution of resistance scores relative to the population structure within each serotype across the Massachusetts and Maela populations. Each colour represents a different sequence cluster, such that they can be distinguished within a serotype.
a, Parameterising the ordinary differential equation (ODE) model. The solid lines (stochastic model output) and dashed lines (ODE model output) show the post-vaccine rate of serotype replacement. They demonstrate that the deterministic ODE model is appropriately parameterised to replicate the post-PCV7 temporal dynamics of the stochastic model, which was directly fitted to genomic surveillance data. b, Serotype frequencies observed in the genomic data (horizontal axis) and in simulations (vertical axis). The outputs of the NFDS model (blue) were compared to those from a neutral ‘proportional replacement’ model (red), in which each non-vaccine serotype expanded to replace the eliminated vaccine serotypes in proportion to its original carriage prevalence. The best-fitting linear relationships are shown by the corresponding coloured lines, and the surrounding shaded regions represent the 95% confidence intervals for each. The NFDS model correlates more strongly with the observed data (Pearson correlation, n = 32, R2 = 0.90) than the neutral model (Pearson correlation, n = 32, R2 = 0.78). c, This plot compares the predicted frequencies of pneumococcal sequence clusters 10 years post-PCV7 when using the ODE and stochastic NFDS models (n = 100 replicates for both versions of the stochastic model). The differences between the ODE and stochastic models are smaller than the differences between alternative mechanisms of strain migration implemented in the stochastic NFDS model (see Methods for details), demonstrating the ODE implementation to accurately replicate the population dynamics of the stochastic implementation.
These scatterplots compare the IPD burden measures used for vaccine optimisation at 10 and 25 years post-vaccination in Massachusetts (n = 480 optimised formulations in each plot) and Maela (n = 440 optimised formulations in each plot). Each plot also displays the simulated effect of introducing PCV13 into a vaccine-naïve population. Plots are separated by population and IPD burden measure. Points are coloured by the constraint on the formulation, and the criterion used for optimisation. The line of identity is marked in black. The IPD measures are very similar at the two timepoints, indicating that while the model dynamics have long transient behaviour driven by drift among similar genotypes, the IPD burden criteria converge towards a feasible-time value relatively early.
Variation in invasiveness between serotypes in infants and adults. Each bar represents the logarithmic invasiveness odds ratios for a serotype, estimated from the meta-analyses of IPD and carriage isolates (Supplementary Tables 1–3) using a random effects model. The 95% confidence intervals associated with these estimates are shown by the error bars. The number of studies contributing to the estimates for each age group for each serotype are enumerated at the top of the plot, with the individual study estimates overlaid as individual points. Results are coloured according to the currently-available vaccines in which the serotype is found, if any. a, Invasiveness in infants relative to carriage in infants. b, Invasiveness in adults relative to carriage in infants. Fewer serotypes are present in this panel, as there were fewer datasets available to estimate these values.
Extended Data Fig. 5 Post-vaccine populations forecast following optimised 20-valent PCV introductions.
Differences in serotype prevalences, forecast 10 years after vaccine introduction, between the best-performing 20-valent strategies optimised under different criteria in a, Massachusetts, and b, Maela. Bars are coloured according to whether they represent the frequency of a vaccine or non-vaccine serotype in the corresponding formulation. In Massachusetts, serotypes 6C, 11A, 15B/C and 35B are typically prevalent in the post-vaccine population regardless of the optimisation criterion, owing to their low infant invasiveness. Serotypes 15A and 23A are higher when minimising infant IPD, whereas serotypes 6A and 23B are higher when minimising overall IPD, in accordance with their age-specific invasiveness (Extended Data Fig. 4). Minimising AMR IPD results in higher prevalence of serotype 10A, which is pansusceptible in Massachusetts. In Maela, all optimal formulations result in high post-vaccine prevalences of serotypes 6A, 6C, 11A, 15F, 19B, as well as non-typeables. Serotypes 19F and 23F remain prevalent when optimising for overall and infant IPD, respectively; both are suppressed when optimising for AMR IPD, owing to their antibiotic resistance profiles (Fig. 5). These are partially replaced by serotypes 6B and 34, which have a weaker association with resistance.
This barchart shows the prevalences of the intermediate-frequency protein antigens within each serotype with at least 10 representatives across the Massachusetts and Maela populations.
a-b, These plots summarise the formulations of PCVs optimised with pneumococcal carrier proteins in a, Massachusetts and b, Maela. Results are displayed as in Fig. 2c,d, except that the first column denotes the carrier protein on which the design was based. Rows are ordered first by the featured pneumococcal carrier protein, and then by the predicted post-vaccine infant IPD burden, which the formulations were designed to minimise. c-d, These plots summarise the compositions of complementary adult vaccines (CAVs) designed to minimise adult IPD following introduction of infant vaccines to minimise AMR IPD (corresponding to the vaccines in Fig. 5) in c, Massachusetts and d, Maela. On each row, the light blue cells define the infant formulation, and the dark blue cells define the adult formulation. Rows are ordered by the overall IPD burden estimated following the implementation of the combined vaccination strategy.
Performance of vaccination strategies judged by different criteria: a, minimising infant IPD; b, minimising overall IPD; c, minimising AMR IPD. Each violin plot is labelled with the constraint on formulation design, and coloured according to the criterion optimisation was intended to minimise. The overlaid points show the estimated effects of each individual optimised formulation (n = 20 for each combination of constraint and optimisation criterion in each population). The purple point in each panel shows the corresponding estimates for PCV13. For the Maela population, no optimisation was performed for two proteins (RrgB2 and ZmpC) that were below the threshold frequency of 0.05 in the starting population (Supplementary Fig. 6), and therefore not included in the multi-locus NFDS simulations. The diminishing returns of expanding infant vaccine valency can be inferred from the predicted effects of the 10-, 15- and 20-valent vaccines relative to the horizontal dashed line, which marks the pre-vaccine value of the optimisation criterion.
Performance of vaccine strategies in the alternative population to that for which they were designed. Simulations of each strategy were run in the alternative population, and their performance compared to that in the intended recipient population using different criteria: minimising infant IPD; minimising overall IPD, and minimising AMR IPD. Panels are labelled to indicate the population for which the formulation was designed. For those panels in which the intended target population was Massachusetts, results are shown for 480 optimised formulations. For those panels in which the intended target population was Maela, results are shown for 440 optimised formulations. Each plot also displays the estimated effect of introducing PCV13 into a vaccine-naïve population. Notably, those vaccines designed to reduce infant and overall IPD in Massachusetts are predicted to perform poorly in Maela.
These scatterplots compare the simulated effectiveness of vaccine formulations in the original multi-locus NFDS model and an otherwise equivalent ‘proportional replacement’ neutral model (Extended Data Fig. 2). Each plot compares the expected post-vaccine IPD burdens expected under NFDS and neutral evolution. Points (n = 480 for the Massachusetts population; n = 440 for the Maela population) are coloured by optimisation constraint and criterion, and the line of identity is marked in black. For the formulations identified by optimization, the results are very similar under both ecological models, with vaccine compositions that we predict to perform better than PCV13 using the NFDS model also tending to do so in the neutral model. This indicates that the formulations we have identified perform well despite the predicted effects of NFDS, rather than because of them.
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Colijn, C., Corander, J. & Croucher, N.J. Designing ecologically optimized pneumococcal vaccines using population genomics. Nat Microbiol 5, 473–485 (2020). https://doi.org/10.1038/s41564-019-0651-y
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