Efficacy and Safety of the Pneumococcal Conjugate-13 Valent Vaccine in Adults

Abstract

Invasive pneumococcal disease and pneumococcal pneumonia cause substantial morbidity and mortality in the elderly. This review focuses on the immunogenicity, safety, efficacy and effectiveness data on the use of the 13-valent conjugate pneumococcal vaccine (PCV13) in adults. A MEDLINE literature search was performed from January 1946 to December 2017. Additional references were identified from a review of literature citations. All English-language randomized trials, observational studies and meta-analyses assessing the immunogenicity, efficacy, effectiveness and safety of PCV13 in adults were evaluated. Six randomized controlled studies evaluated immunogenicity and safety of PCV13 in adults and showed that the conjugated vaccine elicited a greater immune response to the majority of the 13 serotypes compared to the 23-valent polysaccharide pneumococcal vaccine (PPV23). Administering PCV13 prior to PPV23 elicits greater immune responses and multiple doses of PCV13 demonstrated modest advantage. PCV13 titers declined after a year but remained above baseline. A randomized clinical trial (CAPiTA) showed that PCV13 was effective in preventing community-acquired pneumonia (CAP) and vaccine-type invasive pneumococcal disease, but not any cause pneumonia. Safety data shows PCV13 elicits minor local reactions, such as pain at the injection site. Major side effects that were commonly reported included muscle fatigue and headache. Both local and systemic adverse events were comparable to PPV23. While PCV13 has a well-established immunogenicity and safety profile in adults, there is sparse data on sequential or multiple dosing, efficacy and effectiveness in adults. As there are few countries who have adopted PCV13 for routine adult immunization, there is a need to evaluate the effectiveness of PCV13 in a real-world setting.

An observational study of the reactogenicity and immunogenicity of 13-valent pneumococcal conjugate vaccine in women of childbearing age in Papua New Guinea

“…Administration of PCV13 in healthy adult women of childbearing age in PNG was demonstrated to be safe and immunogenic. Comparable to reports for adults in low-endemicity settings [23], local site effects of PCV13 were mild and transient and there were no vaccine-related serious adverse effects. PCV13 vaccination resulted in increased serotypespecific IgG antibody titers in most vaccinated women 1 month after vaccination, confirming PCV13 is immunogenic in PNG adult women.…”

The epidemiologic and biologic basis for classifying older age as a high-risk, immunocompromising condition for pneumococcal vaccine policy

“…In contrast, the antibody response to the highly immunogenic protein carrier conjugated to polysaccharide in PCVs results in a T-cell dependent anti-capsular response, mediated by B2-B cells, which generate high affinity antibodies with isotype switching and the induction of immunological memory [119,120]. In older age the number of B2-B cells also declines, but the superior quality of the immune response to glycoconjugate confers distinct advantages over a plain polysaccharide underlining the benefits of PCVs in older age [121,122].…”

PspA Diversity, Serotype Distribution and Antimicrobial Resistance of Invasive Pneumococcal Isolates from Paediatric Patients in Shenzhen, China

“…They show enhanced immunogenicity. 7 Since the introduction of PCVs, the incidence of IPDs caused by nonvaccine serotypes has increased drastically worldwide. [8][9][10] However, the PCVs can`t cover all serotypes.…”