2718. Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in US Adults Hospitalized with Pneumonia, 2014–2017

Abstract Background Efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) against pneumococcal pneumonia in adults aged >65 years was shown in a 2014 clinical trial. However, its benefits in countries with a mature PCV infant program remain unclear. In August 2014, PCV13 was recommended for all US adults aged >65 years. We evaluated the direct effect of this recommendation on pneumonia hospitalizations among the elderly. Methods We analyzed claims data from US Medicare beneficiaries aged >65 years enrolled in part A/B during September 1, 2014 through December 31, 2017. Participants were followed until they died, left part A/B, or developed a study outcome: community-acquired pneumonia (CAP), non-healthcare-associated CAP (non-HA CAP) or lobar pneumonia (LP). We identified outcomes using inpatient diagnosis codes, and vaccination status using procedure codes. We used discrete-time survival models, stratified by influenza season (October–April) and influenza vaccination status, to estimate incidence rate ratios (IRR) by pneumococcal vaccination status (PCV13-only vs. no pneumococcal vaccination). We adjusted for demographic factors, healthcare utilization, month/year of hospital discharge, and underlying conditions. We derived vaccine effectiveness (VE) and number of hospitalizations averted by PCV13 from the IRRs. Results Of 26.6 million beneficiaries in September 2014, 43.4% were male, 54.2% were aged 65–74 years, and 28.9% had a Charlson comorbidity score >3. PCV13 coverage increased from 0.8% in September 2014 to 41.5% in December 2017. Annual incidence of CAP, non-HA CAP, and LP are shown in the figure. PCV13-vaccinated persons were more likely to be older, sicker, and have received flu vaccine than unvaccinated persons. VE estimates for CAP, non-HA CAP, and LP ranged from 6.0–11.4%, 5.0–11.0%, and 1.3–11.0%, respectively. From September 2014 to December 2017, an estimated 28,600 (95% CI: 21,000–36,000) CAP, 18,700 (12,000–25,800) non-HA CAP and 1,100 (190–1,900) LP hospitalizations were averted. Conclusion Within 40 months after implementation of the adult PCV13 program, 2.0% (28,600) of US CAP hospitalizations were averted. Despite PCV13 effectiveness against adult CAP, only a small fraction of CAP hospitalizations was prevented. Disclosures All authors: No reported disclosures.

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Pneumococcal Vaccination Among Medicare Beneficiaries Occurring After the Advisory Committee on Immunization Practices Recommendation for Routine Use Of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults Aged ≥65 Years

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6627a4 ◽

2017 ◽

Vol 66 (27) ◽

pp. 728-733 ◽

Cited By ~ 22

Author(s):

Carla L. Black ◽

Walter W. Williams ◽

Rob Warnock ◽

Tamara Pilishvili ◽

David Kim ◽

...

Keyword(s):

Advisory Committee ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Vaccination ◽

Polysaccharide Vaccine ◽

Pneumococcal Polysaccharide Vaccine ◽

Medicare Beneficiaries

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Faculty Opinions recommendation of Early impact of 13-valent pneumococcal conjugate vaccine on community-acquired pneumonia in children.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718278114.793494408 ◽

2014 ◽

Author(s):

Jeffrey Bergelson

Keyword(s):

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Community Acquired Pneumonia

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Vaccination status and immune response to 13-valent pneumococcal conjugate vaccine in asplenic individuals

Vaccine ◽

10.1016/j.vaccine.2015.02.026 ◽

2015 ◽

Vol 33 (14) ◽

pp. 1688-1694 ◽

Cited By ~ 18

Author(s):

Per Nived ◽

Charlotte Sværke Jørgensen ◽

Bo Settergren

Keyword(s):

Immune Response ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Vaccination Status

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Distribution of 13-Valent pneumococcal conjugate vaccine serotype streptococcus pneumoniae in adults 50 Years and Older presenting with community-acquired pneumonia in Israel

Human Vaccines & Immunotherapeutics ◽

10.1080/21645515.2018.1475811 ◽

2018 ◽

Vol 14 (10) ◽

pp. 2527-2532 ◽

Cited By ~ 2

Author(s):

Gili Regev-Yochay ◽

Michal Chowers ◽

Bibiana Chazan ◽

Elisa Gonzalez ◽

Sharon Gray ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Community Acquired Pneumonia

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Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands

European Respiratory Journal ◽

10.1183/13993003.00325-2015 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1407-1416 ◽

Cited By ~ 56

Author(s):

Marie-Josée J. Mangen ◽

Mark H. Rozenbaum ◽

Susanne M. Huijts ◽

Cornelis H. van Werkhoven ◽

Douwe F. Postma ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

The Netherlands ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Disease ◽

Community Acquired Pneumonia ◽

Base Case ◽

Vaccination Strategies ◽

Vaccine Type

The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects. We examined the cost-effectiveness of PCV13 vaccination in the Netherlands.Using a Markov-type model, incremental cost-effectiveness ratios (ICER) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective. Estimates of quality-adjusted life-years (QALYs), costs, vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospective studies. The base-case was PCV13 vaccination of adults aged 65–74 years compared to no vaccination, assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use. Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted.The ICER for base-case was €8650 per QALY (95% CI 5750–17 100). Vaccination of high-risk individuals aged 65–74 years was cost-saving and extension to medium-risk individuals aged 65–74 years yielded an ICER of €2900. Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of €3100.PCV13 vaccination is highly cost-effective in the Netherlands. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries.

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Post hoc analysis of the efficacy of the 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia in at-risk older adults

Vaccine ◽

10.1016/j.vaccine.2018.01.049 ◽

2018 ◽

Vol 36 (11) ◽

pp. 1477-1483 ◽

Cited By ~ 16

Author(s):

José A. Suaya ◽

Qin Jiang ◽

Daniel A. Scott ◽

William C. Gruber ◽

Chris Webber ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Community Acquired Pneumonia ◽

Post Hoc Analysis ◽

Vaccine Type ◽

Post Hoc

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110413-Valent Pneumococcal Conjugate Vaccine (PCV13) Immunogenicity in the Community Acquired Pneumonia Immunization Trial In Adults (CAPiTA)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.812 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S326-S327

Author(s):

Anna M.M. Van Deursen ◽

Elisabeth A.M. Sanders ◽

Chris Webber ◽

Michael Patton ◽

Daniel A. Scott ◽

...

Keyword(s):

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Community Acquired Pneumonia

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Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine Against Adult Pneumococcal Pneumonia in Rural Western Kenya

Clinical Infectious Diseases ◽

10.1093/cid/ciz139 ◽

2019 ◽

Vol 69 (12) ◽

pp. 2177-2184 ◽

Cited By ~ 2

Author(s):

Godfrey M Bigogo ◽

Allan Audi ◽

Joshua Auko ◽

George O Aol ◽

Benjamin J Ochieng ◽

...

Keyword(s):

Blood Culture ◽

Conjugate Vaccine ◽

Low Income ◽

Indirect Effects ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Pneumonia ◽

Low Income Countries ◽

Western Kenya ◽

Before And After ◽

Rate Ratios

Abstract Background Data on pneumococcal conjugate vaccine (PCV) indirect effects in low-income countries with high human immunodeficiency virus (HIV) burden are limited. We examined adult pneumococcal pneumonia incidence before and after PCV introduction in Kenya in 2011. Methods From 1 January 2008 to 31 December 2016, we conducted surveillance for acute respiratory infection (ARI) among ~12 000 adults (≥18 years) in western Kenya, where HIV prevalence is ~17%. ARI cases (cough or difficulty breathing or chest pain, plus temperature ≥38.0°C or oxygen saturation <90%) presenting to a clinic underwent blood culture and pneumococcal urine antigen testing (UAT). We calculated ARI incidence and adjusted for healthcare seeking. The proportion of ARI cases with pneumococcus detected among those with complete testing (blood culture and UAT) was multiplied by adjusted ARI incidence to estimate pneumococcal pneumonia incidence. Results Pre-PCV (2008–2010) crude and adjusted ARI incidences were 3.14 and 5.30/100 person-years-observation (pyo), respectively. Among ARI cases, 39.0% (340/872) had both blood culture and UAT; 21.2% (72/340) had pneumococcus detected, yielding a baseline pneumococcal pneumonia incidence of 1.12/100 pyo (95% confidence interval [CI]: 1.0–1.3). In each post-PCV year (2012–2016), the incidence was significantly lower than baseline; with incidence rate ratios (IRRs) of 0.53 (95% CI: 0.31–0.61) in 2012 and 0.13 (95% CI: 0.09–0.17) in 2016. Similar declines were observed in HIV-infected (IRR: 0.13; 95% CI: 0.08–0.22) and HIV-uninfected (IRR: 0.10; 95% CI: 0.05–0.20) adults. Conclusions Adult pneumococcal pneumonia declined in western Kenya following PCV introduction, likely reflecting vaccine indirect effects. Evidence of herd protection is critical for guiding PCV policy decisions in resource-constrained areas.

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