Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017

Abstract

S treptococcus pneumoniae is a major cause of illness and death among adults (1). Pneumonia is the most common form of pneumococcal disease in adults, whereas invasive pneumococcal disease (IPD), including meningitis and bacteremia, has severe clinical manifestations with a high case-fatality ratio (2). Because incidence of adult IPD is high among older adults, it is a public health concern, particularly in countries with aging populations, such as Japan (3,4). Two types of pneumococcal vaccines are currently available for adults: the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV13). According to a systematic review, the effectiveness of PPSV23 against IPD among adults >50 years of age was 54% (5). The CAPITA trial showed that the efficacy of PCV13 against IPD among adults >65 years of age was 75% (6). Since 2014, both PPSV23 and PCV13 have been recommended for older persons in the United States (7), whereas only PPSV23 is recommended in other high-income countries. Discussions over adult pneumococcal vaccination programs are complicated because of differences in vaccine effectiveness (VE) by serotype and age group. Previous studies have suggested that VE of PPSV23 differs by serotype (8,9), so overall VE might vary on the basis of the distribution of serotypes among the vaccinated population. In many countries, the proportion of PCV-covered serotypes among adult IPD patients has been decreasing since the introduction of pediatric PCVs (10-13); this

Distribution and Variation of Serotypes and Pneumococcal Surface Protein A Clades of Streptococcus pneumoniae Strains Isolated From Adult Patients With Invasive Pneumococcal Disease in Japan

“…PPSV23 was included for those aged ≥65 years in Japanese national vaccine program in 2014. The adjusted vaccine effectiveness of PPSV23 against adult IPD caused by vaccine serotypes was 42.2% ( Shimbashi et al, 2020 ). Furthermore, it was shown that prior vaccination with either PCV13 or PPSV23 decreased the risk of pneumococcal carriage in adults aged ≥65 years ( Branche et al, 2018 ).…”

“…The quellung reaction was used for serotype determination with pneumococcal antisera (Statens Serum Institut, Copenhagen, Denmark). Serotype 11A/E and non-typeable (NT) were determined as described previously ( Shimbashi et al, 2020 ).…”

“…PCV13 and PPSV23 have already been licensed for adults, and PPSV23 for those aged ≥65 years has been included in the Japanese NIP from October 2014. We have been studying epidemiology and clinical features of IPD in adults residing in 10 prefectures of Japan (the same area as this study) since 2013 ( Fukusumi et al, 2017 ; Shimbashi et al, 2019 ; Shimbashi et al, 2020 ).…”

Pneumococcal Vaccination Coverage and Uptake Among Adults in Switzerland: A Nationwide Cross-Sectional Study of Vaccination Records

“…Older individuals are known to be among those most at-risk of severe pneumococcal disease [23; 24], indicating the importance of effective pneumococcal vaccination in this group. Recommendation of PPSV23 vaccination, however, was not found to be associated with declines in invasive disease in Switzerland, England or Japan [12; 25; 26; 27]. A recent study of IPD cases in Switzerland found that 30% are caused by serotypes present in PCV13 (and −7).…”

Pneumococcal vaccination in adult patients with comorbidities: a review of the clinical practice guidelines

“…Несмотря на значительное снижение у взрослых в течение исследуемого периода доли ИПИ, вызванных серотипами, представленными в ПКВ13 (с 45% до 31%), изменение эффективности ППВ23 в от ношении ИПИ, вызванных входящими в полисахарид ную вакцину серотипами, было невыраженным (с 47,1% до 39,3%) и практически отсутствовало у лиц пожилого возраста (с 39,9% до 39,4%). Таким образом, данное исследование продемонстрировало, что широкое вне дрение программы иммунизации детей ПКВ13 оказы вает незначительное влияние на эффективность ППВ23 в отношении ИПИ у взрослых пациентов [15].…”