are members of the German Standing Committee on Vaccination (STIKO).
Bundesgesundheitsblatt -Gesundheitsforschung -Gesundheitsschutz 12 · 2016 1624Tätigkeitsberichte Summary Background and objective The incidence of pneumococcal diseases among adults increases with age. Therefore, Germany's Standing Committee on Vaccination (Ständige Impfkommission, STIKO) has since 1998 recommended vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all people aged ≥60 years. PPSV23 has been the only pneumococcal vaccine licensed for adults until few years ago. Universal pneumococcal vaccination of infants, using a conjugate vaccine, has been recommended by STIKO since 2006. Since then, pneumococcal serotypes contained in conjugate vaccines have declined among cases of pneumococcal disease not only in children, but -through herd protection -also in older adults. The 13-valent pneumococcal conjugate vaccine (PCV13), currently used for most infants in Germany, has now been approved for use in adults as well. Data on the efficacy of PCV13 against clinical endpoints in older adults was published in 2015. For that reason, STIKO investigated whether one of the two vaccines (or the combination of both) should be preferred in order to reduce the burden of pneumococcal diseases in older adults, and at what age the vaccine should be given.
Efficacy against invasive pneumococcal diseasesPooled data from 4 randomised controlled trials (RCTs) of PPSV23 in older adults show an efficacy of 73 % against invasive pneumococcal disease (IPD) caused by any serotype (95 % confidence interval [CI], 10-92 %). The IPD cases in these studies were mostly caused by one of the 23 serotypes contained in the vaccine. The efficacy of PCV13 in older adults was investigated in one RCT. Efficacy against IPD by any serotype was 49 % (95 % CI, 21-67 %, modified-intention-to-treat analysis). Efficacy against IPD by the 13 serotypes contained in the vaccine (VT-IPD) was 76 % (95 % CI, 47-90 %).
Efficacy against pneumococcal pneumoniaAfter exclusion of 2 RCTs with a high risk of bias, pooled efficacy of PPSV23 against pneumococcal pneumonia (PP) caused by any serotype in the remaining 2 RCTs was 64 % (95 % CI, 35-80 %). In the included observational studies, pooled efficacy ranged from 37 % to 53 %, with broadly overlapping CIs, depending on study type. The efficacy of PCV13 against PP caused by any serotype was 22 % (95 % CI, 2-39 %), and against VT-PP it was 38 % (95 % CI, 14-55 %).
Anticipated epidemiological and health economic effectsThe above-mentioned studies do not provide clear evidence of a difference between the two vaccines regarding efficacy against clinical endpoints (IPD, PP) caused by the serotypes contained in the respective vaccine. In the 2015-'16 season, 70 % of IPD cases in people aged ≥60 years were caused by PPSV23 serotypes, but only 30 % by PCV13 serotypes. Because PPSV23 contains all the serotypes in PCV13 (except for serotype 6A), vaccination with PPSV23 confers broader serotype coverage and can thereby prevent ...