Marked Reduction of Socioeconomic and Racial Disparities in Invasive Pneumococcal Disease Associated With Conjugate Pneumococcal Vaccines

Abstract

BACKGROUND It is not known whether reductions in socioeconomic and racial disparities in incidence of invasive pneumococcal disease (defined as the isolation of Streptococcus pneumoniae from a normally sterile body site) noted after pneumococcal conjugate vaccine introduction have been sustained. METHODS Individual-level data collected from twenty Tennessee counties participating in Active Bacterial Core surveillance over 19 years were linked to neighborhood-level socioeconomic factors. Incidence rates were analyzed across three periods, pre-PCV7 (1998–1999), pre-PCV13 (2001–2009) and post-PCV13 (2011–2016) by socioeconomic factors. RESULTS 8,491 cases of invasive pneumococcal disease were identified. Incidence for invasive pneumococcal disease decreased from 22.9 (1998–1999) to 17.9 (2001–2009) to 12.7 (2011–2016) cases per 100,000-person years. Post-PCV13 incidence of PCV13-serotype disease in high and low poverty neighborhoods were 3.1 (95% CI: 2.7-3.5) and 1.4 (1.0-1.8) respectively, compared with pre-PCV7 incidence of 17.8 (15.7-19.9) and 6.4 (4.9-7.9). Before PCV introduction, incidence of PCV13-serotype disease was higher in blacks than whites (black: 17.3 [15.10-19.50]; white: 11.8 [10.6-13.0]); after introduction, PCV13-type disease incidence was greatly reduced in both groups (white: 2.7 [2.4-3.0]; black: 2.2 [1.8-2.6]).

Assessment of the Inclusion of Racial/Ethnic Minority, Female, and Older Individuals in Vaccine Clinical Trials

“…A lack of reporting is a key finding of our study, and missing data may be important in the context of understanding health disparities, such as social determinants of health (eg, socioeconomic barriers), implicit bias, and an increased burden of comorbidities. 24 , 27 , 28 , 29 , 30 , 31 , 32 , 33 For example, neighborhood poverty level has been associated with significant disparities in pneumococcal disease incidence among patients with vaccine and nonvaccine serotypes. 31 These findings, combined with studies that document lower vaccination rates and increased disease burdens in some of these populations, demonstrate the need to improve minority group enrollment in clinical trials.…”

“…24,[27][28][29][30][31][32][33] For example, neighborhood poverty level has been associated with significant disparities in pneumococcal disease incidence among patients with vaccine and nonvaccine serotypes. 31 These findings, combined with studies that document lower vaccination rates and increased disease burdens in some of these populations, demonstrate the need to improve minority group enrollment in clinical trials. [34][35][36] Our findings suggest that NIH policies on reporting of identified groups has increased over time, but a need to focus such policies beyond reporting to representative enrollment remains.…”

Pneumococcal vaccination for adults

“…It is important that NPs recognize that health disparities exist in pneumococcal disease and take extra care in ensuring for vaccination of socially disadvantaged populations, who are less likely to be vaccinated for pneumococcal pneumonia and who are more likely to suffer morbidity and mortality from invasive pneumococcal disease. 5,37 When looking at race and ethnicity, the CDC reports persistently higher pneumococcal vaccination uptake among White Americans when compared to Black, Hispanic, and Asian Americans age 65 and over, with the most recent data revealing as much as a 24.3% difference in vaccination rate based on race or ethnicity (see Pneumococcal vaccination rates in 2020 by race/ethnicity). 4 McLaughlin and colleagues also reported significant differences in pneumococcal vaccination rates in comparing non-Hispanic White Americans to Black and Hispanic Americans, and they emphasized that these disparities persisted even when controlling for other factors such as education level, income, occupation, and place of residence.…”

“…Raman and colleagues looked specifically at health disparities in invasive pneumococcal disease by race and socioeconomic status over a nearly 2-decade period, ending in 2016 37. Over this period, the authors found a significant reduction in racial and socioeconomic disparities in cases of invasive pneumococcal disease that involved serotypes covered by PCVs.…”

“…Strongly promoting and optimizing timing of pneumococcal vaccinations in qualifying patients of all ages will help to protect individuals from both invasive and noninvasive S. pneumoniae . It is important that NPs recognize that health disparities exist in pneumococcal disease and take extra care in ensuring for vaccination of socially disadvantaged populations, who are less likely to be vaccinated for pneumococcal pneumonia and who are more likely to suffer morbidity and mortality from invasive pneumococcal disease 5,37…”