Evaluating clinical effectiveness and impact of anti-pneumococcal vaccination in adults after universal childhood PCV13 implementation in Catalonia, 2017–2018

• Published in: Vaccine: X 2023-04, Vol.13, p.100264-100264, Article 100264
• Main Authors: Vila-Córcoles, Angel, Ochoa-Gondar, Olga, de Diego-Cabanes, Cinta, Satué-Gracia, Eva M., Torras-Vives, Verónica, Forcadell-Peris, M. José, Ribas-Seguí, Domingo, Vila-Rovira, Angel, Rodríguez-Casado, Clara
• Format: Article
• Language: English
• Subjects: Adults; Effectiveness; Pneumococcal conjugate vaccine; Pneumococcal polysaccharide vaccine; Pneumococcal vaccination; Pneumonia; Regular paper
• ISSN: 2590-1362; 2590-1362
• DOI: 10.1016/j.jvacx.2023.100264

•Benefits from pneumococcal vaccination in adults are uncertain at present.•In Catalonia, in 2017–18, pneumococcal disease burden in adults remains considerable.•Clinical effectiveness of PCV13/PPsV23 has not emerged after free PCV13 for children. 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