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EClinicalMedicine. 2019 Jan 2;6:42-50. doi: 10.1016/j.eclinm.2018.12.007. eCollection 2018 Dec.

Effectiveness of 23-Valent Polysaccharide Pneumococcal Vaccine and Changes in Invasive Pneumococcal Disease Incidence from 2000 to 2017 in Those Aged 65 and Over in England and Wales.

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Statistics, Modelling, and Economics Department, Public Health England, London, UK.
Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK.
Respiratory Department, Public Health England, London, UK.
Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK.
Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.



Invasive Pneumococcal Disease (IPD) is a major public health concern. The effectiveness of 23-valent polysaccharide pneumococcal vaccine (PPV23) against IPD in older age-groups is not fully understood. We measured PPV23 effectiveness against IPD and interpreted changes in IPD incidence between 2000 and 2017.


Public Health England conducts enhanced national IPD surveillance in England and Wales. The indirect cohort method was used to estimate PPV23 effectiveness against IPD in individuals aged ≥ 65 years eligible for PPV23 vaccination during 2012-2016. IPD incidence in 2016/17 was compared to rates during 2000-2003, when neither PPV23 nor pneumococcal conjugate vaccines (PCVs) were routinely used in England and Wales.


PPV23 effectiveness, irrespective of time since vaccination, was 27% (95% CI, 17-35) after adjusting for age, co-morbidity and year of infection. Vaccine effectiveness reduced non-significantly (p = 0.13) with time since vaccination, from 41% (95% CI, 23-54) for those vaccinated within two years, to 34% (95% CI, 16-48) for those vaccinated 2-4 years previously, and 23% (95% CI, 12-32) for those vaccinated ≥ 5 years previously. Vaccine effectiveness did not vary significantly by age but was highest in previously healthy individuals (45%; 95%CI, 27-59). IPD incidence for PPV23 serotypes not included in the PCVs did not decrease after routine PPV23 use but increased significantly since PCV introduction in 2006.


PPV23 offers moderate short-term protection against IPD in older adults. PPV23 serotypes comprise an increasing proportion of IPD cases in older adults because of serotype replacement following routine PCV use in children.


European Union's Horizon 2020.


Broome method; Effectiveness; Impact; PPV23; Pneumococcal polysaccharide vaccine; Trends

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