Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination

Hanquet, Germaine; Křížová, Pavla; Valentiner‐Branth, Palle; Ladhani, Shamez; Nuorti, J. Pekka; Lepoutre, A.; Mereckiene, Jolita; Knol, Mirjam J.; Winje, Brita Askeland; Ciruela, Pilar; Ordobás, María; Guevara, Marcela; McDonald, Eisin; Morfeldt, Eva; Kozáková, Jana; Slotved, Hans Christian; Fry, Norman K.; Rinta-Kokko, Hanna; Varon, Emmanuelle; Corcoran, Mary; Ende, Arie van der; Vestrheim, Didrik Frimann; Muñoz‐Almagro, Carmen; Zamalloa, Pello Latasa; Castilla, Jesús; Smith, A. Gordon; Henriques‐Normark, Birgitta; Whittaker, Robert; Celentano, Lucia Pastore; Savulescu, Camelia

doi:10.1136/thoraxjnl-2018-211767

Cited by 128 publications

(105 citation statements)

References 39 publications

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“…Neither was there a reduction in pneumonia among the elderly in Australia, and studies from the UK and Denmark have observed similar increases of AC-CAP in the elderly as in our study [13,14,16,27,28]. Our results are in accordance with the moderate impact of the PCV-CIP on the IPD incidence in the elderly observed both in Sweden, and in a multinational European study [8,29]. The European study reported an overall non-significant decline of 9% (CI À4% to 19%) in the IPD incidence in 2015 compared with 2009 (pre-PCV10/13 period) among subjects ≥ 65 years of age, and the incidence of non-PCV13 serotypes increased by 63% (CI 39% to 91%).…”

Section: (A)supporting

confidence: 91%

The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

et al. 2019

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Background There is limited evidence on the impact of pneumococcal conjugate vaccine childhood immunization programmes (PCV‐CIP) on community‐acquired pneumonia (CAP) in individuals with underlying diseases. Methods A nationwide cohort study using Swedish health registers to assess the incidence of hospitalization with all‐cause (AC‐CAP) and pneumococcal or lobar (PL‐CAP) CAP between 2005 and 2015, in relation to PCV‐CIP introduction in 2007–09. Results In total, 303 691 episodes of AC‐CAP occurred, of which 14 225 were PL‐CAP. Comparing before (2005–06) with after (2014–15) PCV‐CIP, relative incidence reductions were 36% (95% Confidence Interval 32–40), 20% (14–25) and 16% (11–22) of AC‐CAP for age groups < 2, 2–4 and 5–17 years, respectively, with similar reductions in young children with and without comorbidities. The reductions were more pronounced for PL‐CAP. In the age groups 40–64, 65–74, 75–84 and ≥85 years there were relative increases of 11% (8–14), 18% (15–22), 15% (12–17) and 30% (27–34) of AC‐CAP, respectively, but these increases were attenuated after adjustment for admittance practices using four control conditions. In adults with comorbidities, there was an increase in incidence of AC‐CAP, and PL‐CAP, in contrast to adults without reported underlying diseases where the incidence was stable or diminished for some age groups. Over the study period, there was an increased proportion of pneumonia patients with underlying diseases in all ages. Conclusion This emphasizes that direct preventive interventions should be targeted towards individuals with underlying diseases. Future studies should investigate reasons for the observed increased risk in adults with comorbidities, for example due to pneumococcal nonvaccine serotypes, or other pathogens, preferentially affecting subjects with underlying diseases.

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Section: (A)supporting

confidence: 91%

The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

et al. 2019

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“…Other countries have reported IPD reduction rates ranging from 16% (Regev-Yochay et al, 2017) to 42% (Cabaj et al, 2016;Chalmers et al, 2016), and a greater decrease (65%) in PCV13 serotypes (Regev-Yochay et al, 2017) than those found in the present study. A multicentre European study reported a lower decline in IPD incidence (9%) than in the present study, with large reductions in PCV13 serotypes and an increase in non-PCV13 serotypes (63%) in 2011-2015 compared with 2009 (Hanquet et al, 2018).…”

Section: Discussioncontrasting

confidence: 75%

“…It could be necessary to improve vaccinationwith PPV23 in older people, mainly those with risk factors for IPD. PPV23 effectiveness against IPD remains unclear (Hanquet et al, 2018;Marrie et al, 2011;Jansen et al, 2009), but it is recommended in persons at risk of IPD and older people (Generalitat de Catalunya, Departament de Salut, 2018). Studies on the effectiveness of PPV23 focusing on specific serotypes and the time of vaccination should be considered.…”

Section: Discussionmentioning

confidence: 99%

Indirect effects of paediatric conjugate vaccines on invasive pneumococcal disease in older adults

Domı́nguez

Ciruela

Izquierdo

et al. 2019

International Journal of Infectious Diseases

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The aim of this study was to assess the indirect effect of paediatric 13-valent pneumococcal conjugate vaccine (PCV13) vaccination on people !65 years of age with invasive pneumococcal disease (IPD) in Catalonia and to determine factors predictive of mortality. Methods: During 2014-2016, 1285 IPD cases were reported to the Public Health Agency of Catalonia. The indirect effect of paediatric PCV13 vaccination was calculated by comparing the incidence rate (IR) in 2016 (PCV13 year) with that in 2009 (pre-PCV13). Predictors of mortality were determined using multivariate logistic regression. Results: Comparing 2016 and 2009, IPD decreased by 19% (IR 40.1 and 32.5 per 100 000 person-years, respectively). PCV13 serotypes decreased by 57% (IR 23.7 and 10.1), while non-PCV13 serotypes increased by 36% (IR 16.4 and 22.4). During 2014-2016, the mortality rate was 17.5%, and mortality was associated with age !85 years (adjusted odds ratio (aOR) 2.91, 95% confidence interval (CI) 1.89, 4.48), meningitis (aOR 2.29, 95% CI 1.25, 4.19), non-focal bacteraemia (aOR 3.73, 95% CI 2.00, 6.94), and !1 high-risk condition (aOR 1.89, 95% CI 1.08, 3.32). PPV23non13 serotypes were associated with lower mortality than PCV13 serotypes (aOR 0.54, 95% CI 0.34, 0.86). Conclusions: The incidence of IPD in people !65 years of age decreased after the introduction of paediatric PCV13, and this was due to a reduction in PCV13 serotypes, although an increase in non-PCV13 serotypes was observed. Mortality was associated with age, meningitis, non-focal bacteraemia, !1 high-risk condition, and PCV13 serotypes.

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“…This could also lead to a lower estimated VE of the conjugate vaccine in Spain compared to CAPITA results from the Netherlands with a very low background PPV23 vaccination rate in the elderly population. Finally, this region of Spain has had a large reduction in circulating PCV13 serotypes due to the indirect effect of the PCV childhood immunization [29]. In a population with a significant reduction in PCV13 serotypes, the preventative potential of PCV13 is lower than in a population with a high proportion of circulating PCV13 serotypes.…”

Section: Evidence Base For Pcv13mentioning

confidence: 99%

A Systematic Review of Studies Published between 2016 and 2019 on the Effectiveness and Efficacy of Pneumococcal Vaccination on Pneumonia and Invasive Pneumococcal Disease in an Elderly Population

et al. 2020

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Adult vaccination is high on the agenda in many countries. Two different vaccines are available for the prevention of pneumococcal disease in adults: a 23-valent polysaccharide vaccine (PPV23), and a 13-valent conjugated vaccine (PCV13). The objective of this review is to update the evidence base for vaccine efficacy and effectiveness of PPV23 and PCV13 against invasive pneumococcal disease and pneumonia among an unselected elderly population. We systematically searched for clinical trials and observational studies published between January 1 2016 and April 17 2019 in Pubmed, Embase, Cinahl, Web of Science, Epistemonikos and Cochrane databases. Risk of bias was assessed using Cochrane Risk of Bias tool for and the Newcastle–Ottawa Scale. Results were stratified by vaccine type and outcome. We identified nine studies on PCV13 and six on PPV23. No new randomized clinical trials were identified. Due to different outcomes, it was not possible to do a meta-analysis. New high-quality observational studies indicate protective vaccine effectiveness for both vaccines against vaccine type pneumonia. Our estimates for the protective vaccine efficacy and effectiveness (VE) of PPV23 on pneumonia and pneumococcal pneumonia overlap with results from previously published reviews. Some of the results indicate that the effectiveness of the PPV23 is best in younger age groups, and that it decreases over time.

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Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination

Cited by 128 publications

References 39 publications

The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

Indirect effects of paediatric conjugate vaccines on invasive pneumococcal disease in older adults

A Systematic Review of Studies Published between 2016 and 2019 on the Effectiveness and Efficacy of Pneumococcal Vaccination on Pneumonia and Invasive Pneumococcal Disease in an Elderly Population

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