Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Medically Attended Lower Respiratory Tract Infection and Pneumonia Among Older Adults

Joseph A Lewnard; Katia J Bruxvoort; Heidi Fischer; Vennis X Hong; Lindsay R Grant; Luis Jódar; Alejandro Cané; Bradford D Gessner; Sara Y Tartof

doi:10.1093/cid/ciab1051

Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Medically Attended Lower Respiratory Tract Infection and Pneumonia Among Older Adults

Clin Infect Dis. 2022 Sep 14;75(5):832-841. doi: 10.1093/cid/ciab1051.

Authors

Joseph A Lewnard^{1

2

3}, Katia J Bruxvoort^{4

5}, Heidi Fischer⁵, Vennis X Hong⁵, Lindsay R Grant⁶, Luis Jódar⁶, Alejandro Cané⁶, Bradford D Gessner⁶, Sara Y Tartof^{4

7}

Affiliations

¹ Division of Epidemiology, School of Public Health, University of California-Berkeley, Berkeley, California, USA.
² Division of Infectious Diseases & Vaccinology, School of Public Health, University of California-Berkeley, Berkeley, California, USA.
³ Center for Computational Biology, College of Engineering, University of California-Berkeley, Berkeley, California, USA.
⁴ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁵ Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
⁶ Pfizer Vaccines, Collegeville, Pennsylvania, USA.
⁷ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.

PMID: 34967907
DOI: 10.1093/cid/ciab1051

Abstract

Background: Among older adults, 13-valent pneumococcal conjugate vaccine (PCV13) has been found efficacious against nonbacteremic pneumonia associated with vaccine-serotype pneumococci. However, the burden of lower respiratory tract infection (LRTI) and pneumonia preventable by direct immunization of older adults continues to be debated.

Methods: We analyzed data from an open cohort of adults aged ≥65 years enrolled in Kaiser Permanente Southern California health plans from 2016 to 2019 who received PCV13 concordant with US Advisory Committee on Immunization Practices guidelines. We estimated PCV13 vaccine effectiveness (VE) via the adjusted hazard ratio for first LRTI and pneumonia episodes during each respiratory season, comparing PCV13-exposed and PCV13-unexposed time at risk for each participant using a self-matched inference framework. Analyses used Cox proportional hazards models, stratified by individual.

Results: Among 42 700 adults who met inclusion criteria, VE was 9.5% (95% confidence interval [CI], 2.2% to 16.3%) against all-cause medically attended LRTI and 8.8% (95% CI, -.2% to 17.0%) against all-cause medically attended pneumonia. In contrast, we did not identify evidence of protection against LRTI and pneumonia following receipt of the 23-valent pneumococcal polysaccharide vaccine. PCV13 prevented 0.7 (95% CI, .2 to 1.4) and 0.5 (95% CI, .0 to 1.0) cases of LRTI and pneumonia, respectively, per 100 vaccinated persons annually; over 5 years, 1 case of LRTI and 1 case of pneumonia were prevented for every 27 and 42 individuals vaccinated, respectively.

Conclusions: PCV13 vaccination among older adults substantially reduced incidence of medically attended respiratory illness. Direct immunization of older adults is an effective strategy to combat residual disease burden associated with PCV13-type pneumococci.

Keywords: Pneumonia; lower respiratory tract infection; older adults; pneumococcal conjugate vaccine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Pneumococcal Infections* / epidemiology
Pneumococcal Infections* / prevention & control
Pneumococcal Vaccines
Pneumonia, Pneumococcal* / epidemiology
Pneumonia, Pneumococcal* / prevention & control
Respiratory Tract Infections*
Streptococcus pneumoniae
Vaccines, Conjugate

Substances

Pneumococcal Vaccines
Vaccines, Conjugate