Format

Send to

Choose Destination
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.

Author information

1
Statistics, Modelling, and Economics Department, Public Health England, London, UK.
2
Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK.
3
Respiratory Department, Public Health England, London, UK.
4
Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK.
5
Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK.

Abstract

Background:

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.

Methods:

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.

Findings:

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.

Interpretation:

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.

Funding:

European Union's Horizon 2020.

KEYWORDS:

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

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center