Optimal age targeting for pneumococcal vaccination in older adults; a modelling study

Deus Thindwa; Samuel Clifford; Jackie Kleynhans; Anne von Gottberg; Sibongile Walaza; Susan Meiring; Todd D. Swarthout; Elizabeth Miller; Peter McIntyre; Nick Andrews; Zahin Amin-Chowdhury; Norman Fry; Kondwani C. Jambo; Neil French; Samanta Cristine Grassi Almeida; Shamez N. Ladhani; Robert S. Heyderman; Cheryl Cohen; Maria Cristina de Cunto Brandileone; Stefan Flasche

doi:10.1038/s41467-023-36624-8

Optimal age targeting for pneumococcal vaccination in older adults; a modelling study

Deus Thindwa^*, Samuel Clifford, Jackie Kleynhans, Anne von Gottberg, Sibongile Walaza, Susan Meiring, Todd D. Swarthout, Elizabeth Miller, Peter McIntyre, Nick Andrews, Zahin Amin-Chowdhury, Norman Fry, Kondwani C. Jambo, Neil French, Samanta Cristine Grassi Almeida, Shamez N. Ladhani, Robert S. Heyderman, Cheryl Cohen, Maria Cristina de Cunto Brandileone, Stefan Flasche

^*Corresponding author for this work

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Abstract

Invasive pneumococcal disease (IPD) risk increases with age for older adults whereas the population size benefiting from pneumococcal vaccines and robustness of immunogenic response to vaccination decline. We estimate how demographics, vaccine efficacy/effectiveness (VE), and waning VE impact on optimal age for a single-dose pneumococcal vaccination. Age- and vaccine-serotype-specific IPD cases from routine surveillance of adults ≥ 55 years old (y), ≥ 4-years after infant-pneumococcal vaccine introduction and before 2020, and VE data from prior studies were used to estimate IPD incidence and waning VE which were then combined in a cohort model of vaccine impact. In Brazil, Malawi, South Africa and England 51, 51, 54 and 39% of adults older than 55 y were younger than 65 years old, with a smaller share of annual IPD cases reported among < 65 years old in England (4,657; 20%) than Brazil (186; 45%), Malawi (4; 63%), or South Africa (134, 48%). Vaccination at 55 years in Brazil, Malawi, and South Africa, and at 70 years in England had the greatest potential for IPD prevention. Here, we show that in low/middle-income countries, pneumococcal vaccines may prevent a substantial proportion of residual IPD burden if administered earlier in adulthood than is typical in high-income countries.

Original language	English
Article number	888
Journal	Nature Communications
Volume	14
Issue number	1
Early online date	16 Feb 2023
DOIs	https://doi.org/10.1038/s41467-023-36624-8
Publication status	E-pub ahead of print - 16 Feb 2023

Bibliographical note

Funding Information: We thank all the individuals working in respective invasive pneumococcal disease (IPD) surveillance and laboratory management teams in the four countries for providing important data on IPD isolates and related causing serotypes. We would like to thank Stephen Gordon of Liverpool School of Tropical Medicine for insightful discussion and feedback at the initial stage of this work. D.T., K.C.J., S.F., N.F., R.S.H., and T.D.S. are supported by the National Institute for Health Research (NIHR) Global Health Research Unit on Mucosal Pathogens (MPRU) where RSH is a NIHR Senior Investigator. In addition, SF is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society. A project grant from the National Institute for Health and Care Research (NIHR) Global Health Research Unit on Mucosal Pathogens (MPRU) is supported using UK aid from the UK Government (Grant 16/136/46). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The MLW Clinical Research Programme is supported by a Strategic Award from the Wellcome, UK. This research was funded in whole, or in part, by the Wellcome Trust [Grant number 208812/Z/17/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, collection, analysis, data interpretation, writing of the report or in the decision to submit the paper for publication. The corresponding author and senior authors had full access to the study data, and together, had final responsibility for the decision to submit for publication.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not
included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © The Author(s) 2023

Citation: Thindwa, D., Clifford, S., Kleynhans, J. et al. Optimal age targeting for pneumococcal vaccination in older adults; a modelling study. Nat Commun 14, 888 (2023). https://doi.org/10.1038/s41467-023-36624-8

DOI: https://doi.org/10.1038/s41467-023-36624-8

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Cite this

Thindwa, D., Clifford, S., Kleynhans, J., von Gottberg, A., Walaza, S., Meiring, S., Swarthout, T. D., Miller, E., McIntyre, P., Andrews, N., Amin-Chowdhury, Z., Fry, N., Jambo, K. C., French, N., Almeida, S. C. G., Ladhani, S. N., Heyderman, R. S., Cohen, C., de Cunto Brandileone, M. C., & Flasche, S. (2023). Optimal age targeting for pneumococcal vaccination in older adults; a modelling study. Nature Communications, 14(1), Article 888. Advance online publication. https://doi.org/10.1038/s41467-023-36624-8

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abstract = "Invasive pneumococcal disease (IPD) risk increases with age for older adults whereas the population size benefiting from pneumococcal vaccines and robustness of immunogenic response to vaccination decline. We estimate how demographics, vaccine efficacy/effectiveness (VE), and waning VE impact on optimal age for a single-dose pneumococcal vaccination. Age- and vaccine-serotype-specific IPD cases from routine surveillance of adults ≥ 55 years old (y), ≥ 4-years after infant-pneumococcal vaccine introduction and before 2020, and VE data from prior studies were used to estimate IPD incidence and waning VE which were then combined in a cohort model of vaccine impact. In Brazil, Malawi, South Africa and England 51, 51, 54 and 39% of adults older than 55 y were younger than 65 years old, with a smaller share of annual IPD cases reported among < 65 years old in England (4,657; 20%) than Brazil (186; 45%), Malawi (4; 63%), or South Africa (134, 48%). Vaccination at 55 years in Brazil, Malawi, and South Africa, and at 70 years in England had the greatest potential for IPD prevention. Here, we show that in low/middle-income countries, pneumococcal vaccines may prevent a substantial proportion of residual IPD burden if administered earlier in adulthood than is typical in high-income countries.",

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note = "Funding Information: We thank all the individuals working in respective invasive pneumococcal disease (IPD) surveillance and laboratory management teams in the four countries for providing important data on IPD isolates and related causing serotypes. We would like to thank Stephen Gordon of Liverpool School of Tropical Medicine for insightful discussion and feedback at the initial stage of this work. D.T., K.C.J., S.F., N.F., R.S.H., and T.D.S. are supported by the National Institute for Health Research (NIHR) Global Health Research Unit on Mucosal Pathogens (MPRU) where RSH is a NIHR Senior Investigator. In addition, SF is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society. A project grant from the National Institute for Health and Care Research (NIHR) Global Health Research Unit on Mucosal Pathogens (MPRU) is supported using UK aid from the UK Government (Grant 16/136/46). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The MLW Clinical Research Programme is supported by a Strategic Award from the Wellcome, UK. This research was funded in whole, or in part, by the Wellcome Trust [Grant number 208812/Z/17/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, collection, analysis, data interpretation, writing of the report or in the decision to submit the paper for publication. The corresponding author and senior authors had full access to the study data, and together, had final responsibility for the decision to submit for publication. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Publisher Copyright: {\textcopyright} The Author(s) 2023 Citation: Thindwa, D., Clifford, S., Kleynhans, J. et al. Optimal age targeting for pneumococcal vaccination in older adults; a modelling study. Nat Commun 14, 888 (2023). https://doi.org/10.1038/s41467-023-36624-8 DOI: https://doi.org/10.1038/s41467-023-36624-8",

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Thindwa, D, Clifford, S, Kleynhans, J, von Gottberg, A, Walaza, S, Meiring, S, Swarthout, TD, Miller, E, McIntyre, P, Andrews, N , Amin-Chowdhury, Z, Fry, N, Jambo, KC, French, N, Almeida, SCG, Ladhani, SN, Heyderman, RS, Cohen, C, de Cunto Brandileone, MC & Flasche, S 2023, 'Optimal age targeting for pneumococcal vaccination in older adults; a modelling study', Nature Communications, vol. 14, no. 1, 888. https://doi.org/10.1038/s41467-023-36624-8

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T1 - Optimal age targeting for pneumococcal vaccination in older adults; a modelling study

AU - Thindwa, Deus

AU - Clifford, Samuel

AU - Kleynhans, Jackie

AU - von Gottberg, Anne

AU - Walaza, Sibongile

AU - Meiring, Susan

AU - Swarthout, Todd D.

AU - Miller, Elizabeth

AU - McIntyre, Peter

AU - Andrews, Nick

AU - Amin-Chowdhury, Zahin

AU - Fry, Norman

AU - Jambo, Kondwani C.

AU - French, Neil

AU - Almeida, Samanta Cristine Grassi

AU - Ladhani, Shamez N.

AU - Heyderman, Robert S.

AU - Cohen, Cheryl

AU - de Cunto Brandileone, Maria Cristina

AU - Flasche, Stefan

N1 - Funding Information: We thank all the individuals working in respective invasive pneumococcal disease (IPD) surveillance and laboratory management teams in the four countries for providing important data on IPD isolates and related causing serotypes. We would like to thank Stephen Gordon of Liverpool School of Tropical Medicine for insightful discussion and feedback at the initial stage of this work. D.T., K.C.J., S.F., N.F., R.S.H., and T.D.S. are supported by the National Institute for Health Research (NIHR) Global Health Research Unit on Mucosal Pathogens (MPRU) where RSH is a NIHR Senior Investigator. In addition, SF is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society. A project grant from the National Institute for Health and Care Research (NIHR) Global Health Research Unit on Mucosal Pathogens (MPRU) is supported using UK aid from the UK Government (Grant 16/136/46). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The MLW Clinical Research Programme is supported by a Strategic Award from the Wellcome, UK. This research was funded in whole, or in part, by the Wellcome Trust [Grant number 208812/Z/17/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, collection, analysis, data interpretation, writing of the report or in the decision to submit the paper for publication. The corresponding author and senior authors had full access to the study data, and together, had final responsibility for the decision to submit for publication. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Publisher Copyright: © The Author(s) 2023 Citation: Thindwa, D., Clifford, S., Kleynhans, J. et al. Optimal age targeting for pneumococcal vaccination in older adults; a modelling study. Nat Commun 14, 888 (2023). https://doi.org/10.1038/s41467-023-36624-8 DOI: https://doi.org/10.1038/s41467-023-36624-8

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N2 - Invasive pneumococcal disease (IPD) risk increases with age for older adults whereas the population size benefiting from pneumococcal vaccines and robustness of immunogenic response to vaccination decline. We estimate how demographics, vaccine efficacy/effectiveness (VE), and waning VE impact on optimal age for a single-dose pneumococcal vaccination. Age- and vaccine-serotype-specific IPD cases from routine surveillance of adults ≥ 55 years old (y), ≥ 4-years after infant-pneumococcal vaccine introduction and before 2020, and VE data from prior studies were used to estimate IPD incidence and waning VE which were then combined in a cohort model of vaccine impact. In Brazil, Malawi, South Africa and England 51, 51, 54 and 39% of adults older than 55 y were younger than 65 years old, with a smaller share of annual IPD cases reported among < 65 years old in England (4,657; 20%) than Brazil (186; 45%), Malawi (4; 63%), or South Africa (134, 48%). Vaccination at 55 years in Brazil, Malawi, and South Africa, and at 70 years in England had the greatest potential for IPD prevention. Here, we show that in low/middle-income countries, pneumococcal vaccines may prevent a substantial proportion of residual IPD burden if administered earlier in adulthood than is typical in high-income countries.

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Optimal age targeting for pneumococcal vaccination in older adults; a modelling study

Abstract

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