Evaluating clinical effectiveness and impact of anti-pneumococcal vaccination in adults after universal childhood PCV13 implementation in Catalonia, 2017-2018
Vila-Corcoles, Angel (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Ochoa-Gondar, Olga (Institut Català de la Salut)
De Diego-Cabanes, Cinta (Institut Català de la Salut)
Satué-Gracia, Eva M. (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Torras-Vives, Verónica (Institut Català de la Salut)
Forcadell-Peris, M. José (Institut Català de la Salut)
Ribas-Seguí, Domingo (Institut Català de la Salut)
Vila-Rovira, Angel (Institut Català de la Salut)
Rodríguez, Clara (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	At present, because of indirect effects derived from routine childhood immunisation, clinical benefits vaccinating adults with the 23-valent pneumococcal polysaccharide vaccine (PPsV23) and/or the 13-valent pneumococcal conjugate vaccine (PCV13) are uncertain. This study investigated clinical effectiveness for both PPsV23/PCV13 in preventing pneumonia among Catalonian adults during an earlier 2-year period post-PCV13 free (publicly funded) approval for infants. We conducted a Population-based cohort study involving 2,059,645 adults ≥ 50 years in Catalonia, Spain, who were followed between 01/01/2017-31/12/2018. Primary outcomes were hospitalisation from pneumococcal pneumonia (PP) or all-cause pneumonia (ACP) and main explanatory variable was PCV13/PPsV23 vaccination status. Cox regression models were used to estimate vaccination effectiveness adjusted by age/sex and underlying-risk conditions. Cohort members were followed for 3,958,528 person-years (32,328 PCV13-vaccinated, 1,532,186 PPsV23-vaccinated), observing 3592 PP (131 in PCV13-vaccinated vs 2476 in PPsV23-vaccinated) and 24,136 ACP (876 in PCV13-vaccinated vs 17,550 in PPsV23-vaccinated). Incidence rates (per 100,000 person-years) were 90. 7 for PP (394. 2 in PCV13-vaccinated vs 161. 6 in PPsV23-vaccinated) and 609. 7 for ACP (2636. 3 in PCV13-vaccinated vs 1145. 4 in PPsV23-vaccinated). The PCV13 was associated with an increased risk of PP (hazard ratio [HR]: 1. 24; 95% CI: 1. 00-1. 52; p = 0. 046) and ACP (HR: 1. 38; 95% CI: 1. 28-1. 49; p < 0. 001) whereas the PPsV23 did not alter the risk of PP (HR: 1. 07; 95% CI: 0. 98-1. 18; p = 0. 153) and slightly increased the risk of ACP (HR: 1. 14; 95% CI: 1. 10-1. 18; p < 0. 001). In supplementary analyses focused on at-risk individuals (i. e. , elderly persons, immunocompromissing and other chronic illnesses) protective effects of vaccination did not emerge either. Data does not support clinical benefits from pneumococcal vaccination (nor PCV13 neither PPsV23) against pneumonia among Catalonian middle-aged and older adults in the current era of universal PCV13 childhood immunisation in our setting. New extended valency PCVs are greatly needed.
Grants:	Instituto de Salud Carlos III PI20/01223
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Adults ; Effectiveness ; Pneumococcal vaccination ; Pneumococcal conjugate vaccine ; Pneumococcal polysaccharide vaccine ; Pneumonia
Published in:	Vaccine: X, Vol. 13 (january 2023) , ISSN 2590-1362

DOI: 10.1016/j.jvacx.2023.100264
PMID: 36798107

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