Effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal disease in people 60 years or older

Abstract

BackgroundThe 23-valent polysaccharide pneumococcal vaccine (PPV) is currently recommended in elderly and high-risk adults. However, its efficacy in preventing pneumococcal infections remains controversial. This study assessed the clinical effectiveness of vaccination against invasive pneumococcal disease (IPD) among people over 60 years.MethodsPopulation-based case-control study that included 88 case patients over 60 years-old with a laboratory-confirmed IPD (bacteraemic pneumonia, meningitis or sepsis) and 176 outpatient control subjects who were matched by primary care centre, age, sex and risk stratum. Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for underlying conditions. Vaccine effectiveness was estimated as (1 - OR) ×100.ResultsPneumococcal vaccination rate was significantly lower in cases than in control subjects (38.6% vs 59.1%; p = 0.002). The adjusted vaccine effectiveness was 72% (OR: 0.28; 95% CI: 0.15-0.54) against all IPD and 77% (OR: 0.23; 95% CI: 0.08-0.60) against vaccine-type IPD. Vaccination was significantly effective against all IPD in both age groups: 60-79 years-old (OR 0.32; 95% CI: 0.14-0.74) and people 80 years or older (OR: 0.29; 95% CI: 0.09-0.91). Vaccination appears significantly effective as for high-risk immunocompetent subjects (OR: 0.29; 95% CI: 0.11-0.79) as well as for immunocompromised subjects (OR: 0.12; 95% CI: 0.03-0.53).ConclusionThese findings confirm the effectiveness of the 23-valent PPV against IPD, and they also support the benefit of vaccination in preventing invasive infections among high-risk and older people.

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

“…Meta-analyses of five randomized clinical trials have shown that PPV23 is 68% (95% CI 53-78) effective against IPD among immunocompetent older adults. 49 In our analyses, the values for vaccine effectiveness against were based on multiple observational studies which had the advantage of being conducted in large unselected natural populations 11,37,[50][51][52][53][54][55] (Table 3). One of these recent studies, conducted in Scotland in persons aged ≥65 years, demonstrated a protective effect of PPV23 against IPD of 61.7% (95% CI, 45.1-73.2).…”

Immunogenicity of 13-valent pneumococcal conjugate vaccine in immunocompetent older adults with stable underlying medical conditions

“…Several studies have examined the responses to PCV or PPSV vaccination in at-risk adults [13][14][15][16][17][18][19]; to date, no studies specifically examined responses after PCV13 vaccination in at-risk adults. Therefore, in this analysis, we evaluated data from 3 previous studies in immunocompetent PPSV23-naive and PPSV23-preimmunized subjects ≥50 years of age that included a considerable percentage of subjects with stable chronic underlying conditions known to put these subjects at increased risk for pneumococcal disease.…”

Predictors of Mortality Among U.S. Veterans With Streptococcus Pneumoniae Infections

“…40,41 Further, it is possible that some patients did not report vaccinations they received outside of the Veterans Affairs healthcare system to their Veterans Affairs provider; however, this potential misclassification is likely to be low, as the vaccination rate in the overall Veterans Affairs cohort with pneumococcal infection was similar to a community population with serious pneumococcal infections (33% vs 38%). 42 Extrapolation of these results to the general population is also limited, as the population primarily consisted of older white men.…”