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

Abdelmajid Djennad*, Mary Ramsay, Richard Pebody, Norman Fry, Carmen Sheppard, Shamez Ladhani, Nicholas Andrews

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

93 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)42-50
Number of pages9
JournalEClinicalMedicine
Volume6
DOIs
Publication statusPublished - Dec 2018

Bibliographical note

Funding Information:
Invasive pneumococcal disease surveillance is internally funded by Public Health England. The research is funded by a European Commission project I-MOVE + (Integrated Monitoring of Vaccines Effectiveness in Europe) that received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement # 634446 . The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Funding Information:
Invasive pneumococcal disease surveillance is internally funded by Public Health England. The research is funded by a European Commission project I-MOVE + (Integrated Monitoring of Vaccines Effectiveness in Europe) that received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement #634446. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. We thank the staff involved with pneumococcal surveillance at Public Health England for the follow-up of invasive isolates and data collection for confirmed cases. We also thank the staff at hospital laboratories in England and Wales, who referred isolates for serotyping and provided additional information on request.

Publisher Copyright:
© 2018

Keywords

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

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