Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales

Statistics, Modelling and Economics Department, Health Protection Services, Health Protection Agency, London, United Kingdom. Electronic address: .
Vaccine (Impact Factor: 3.62). 11/2012; 30(48):6802–6808. DOI: 10.1016/j.vaccine.2012.09.019


In 2003 the existing 23-valent pneumococcal vaccine (PPV23) programme for high risk groups was extended to include all ≥65 year olds in England and Wales, starting with ≥80 year olds and moving to 75–79 and 65–74 year olds by 2005. We conducted an ecological study to assess the impact of the extended PPV23 programme on serotype-specific incidence of invasive pneumococcal disease (IPD) and a case–control study to assess vaccine effectiveness (VE) using the national IPD surveillance dataset. Between 1998 and 2006 IPD incidence caused by PPV23 serotypes in the targeted age-groups was unchanged. IPD caused by the serotypes covered by the 7-valent conjugate vaccine (PCV7) introduced for children in 2006 declined in ≥65 year olds after 2006 but was offset by an increase in non-PCV7 serotypes. This increase was similar for the additional 16 serotypes covered by PPV23 and the non-PPV23 serotypes. For the VE study, vaccine history was obtained for controls (n = 1270) with non-PPV23 IPD diagnosed between November 2003 and December 2010 and a subset of cases (n = 1272) matched for age and time period. VE declined from 48% (95% confidence interval; 32–60%) within two years of vaccination to 15% (−3% to 30%) after five years. Although differences in VE by age and having risk conditions were not statistically significant the highest estimates were in the youngest age group (65–74 years) and in those without risk conditions with a VE estimate of 65% (23–84%) within 2 years of vaccination for non-risk 65–74 year olds. VE differed by serotype (p = 0.005), from −23% (−85% to 19%) for serotype 3 to 63% (29–81%) for 12F. In conclusion PPV23 was effective, particularly in healthy under 75 year olds, but protection waned after 5 years. There was no discernible impact of PPV23 on IPD incidence or PCV7-induced serotype replacement, consistent with the modest overall effectiveness, the 45% increased coverage over the former risk-based programme and lack of herd immunity from the PPV23 programme. Based on the VE estimates PPV23 was still considered a cost-effective intervention for the low risk elderly.

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    • "A UK study demonstrated 48% vaccine effectiveness against IPD within 2 years of vaccination in elderly adults older than 65 years. The vaccine was statistically significantly effective against IPD in adults aged 75–84 years but not those older than 85 years [24]. In our study, which included more than one million elderly subjects aged 75 years and older, the 23-valent PPV yielded significant protective effects against IPD and pneumonia hospitalization. "
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    ABSTRACT: Infections in Older PatientsSESSION TYPE: Original Investigation SlidePRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PMPURPOSE: A nationwide pneumococcal vaccination program in Taiwan provided 23-valent pneumococcal polysaccharide vaccines (PPV) and seasonal influenza vaccinations to persons aged 75 years and above in 2007 to 2009. The efficacy of these vaccines in 2010 was evaluated.METHODS: Data were analyzed using the Taiwan National Health Insurance Research Database, cause of death database and invasive pneumococcal disease (IPD) notification file of the Taiwan Department of Health. The efficacy of PPV and influenza vaccine in the risk of hospitalization due to pneumonia, invasive pneumococcal disease, mortality due to pneumonia and all-cause mortality were evaluated using propensity score matching (PSM) followed by multivariate logistic regression method.RESULTS: Among the 1,063,116 eligible persons, 46,451 (4.31%) had PPV alone, 203,298 (18.84%) had influenza vaccine alone, 271,806 (25.19%) had both vaccines and 557,400 (51.66%) had not been vaccinated. After PSM, there were 37,348 persons in each group. Those vaccinated with PPV alone or both vaccines had significantly lower risks of pneumonia hospitalization (OR 0.45 and 0.44), deaths due to pneumonia (OR 0.06 and 0.13) and all-cause mortality (OR 0.03 and 0.09) compared to those without PPV vaccination. There were significant lower risks for persons vaccinated with PPV in the development of IPD (OR 0.23). Additional influenza vaccinations had no additive protective effects in pneumonia hospitalization, IPD, deaths due to pneumonia or all-cause mortality.CONCLUSIONS: Vaccination with PPV in persons aged 75 years and older was effective in reducing the risks of pneumonia hospitalization, IPD, all-cause mortality and deaths due to pneumonia.CLINICAL IMPLICATIONS: PPV vaccination to the elderly aged 75 years and old had beneficial effects in reduction of pneumonia and invasive pneumococcal diseases.DISCLOSURE: The following authors have nothing to disclose: Meng-Jer Hsieh, Ying-Huang Tsai, Chee-Jen Chang, Yu-Wen Wen, Han-Chung Hu, Yen-Nan Chao, Yhu-Chering Huang, Cheng-Ta Yang, Chung-Chi HuangNo Product/Research Disclosure Information.
    Full-text · Article · Oct 2013 · Chest
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    • "In addition, there may be some protection through 23-valent pneumococcal polysaccharide vaccine (PPV23) vaccination in the elderly and adults with comorbidities. However, two studies, one in the US (in adults, with and without PPV23 indications) and one in the UK (in those aged ≥65 years), reported that after PPV23 introduction there was no evidence of a decrease in the incidence of IPD (not just meningitis) caused by serotypes in this vaccine; however, after the introduction of PCV7 in the childhood vaccination programmes, there was a reduction in the incidence of IPD caused by the PCV7 serotypes [27, 28]. "
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    ABSTRACT: Streptococcus pneumoniae is the leading cause of bacterial meningitis. Young children, the elderly and those who are immunocompromised or who suffer from chronic diseases have the highest risk of developing pneumococcal meningitis. A 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in 2000 in the US and in 2001 in Europe. A literature search was performed in PubMed to identify studies assessing the impact of routine childhood PCV7 vaccination on pneumococcal diseases. Here, we report the impact on pneumococcal meningitis. A total of 17 articles reporting impact data on pneumococcal meningitis were included in this review: 11 from Western Europe and 6 from North America. In the post-vaccination period, compared with the pre-vaccination period, a reduction ranging from 59.2% in the US, 1 year after vaccine introduction, to 100% in Belgium, 4 years after vaccine introduction in vaccine-type (VT) pneumococcal meningitis incidence was reported in vaccine-eligible children in seven studies. In addition, the majority of studies reported reductions in VT and all-type pneumococcal meningitis incidence in age groups that were not vaccine-eligible. The results from this review demonstrate that PCV7 has had a significant impact on pneumococcal meningitis across all ages through its use in pediatric immunization programs. With the introduction of 13-valent PCV (PCV13) we can expect to see a reduction in the incidence of pneumococcal meningitis due to the six additional serotypes included, as well as continued protection against pneumococcal meningitis due to PCV7 serotypes. Robust surveillance systems are essential for the evaluation of the impact of PCV13 on all-type pneumococcal meningitis and for monitoring the evolution of non-vaccine serotype pneumococcal meningitis.
    Full-text · Article · Sep 2013 · Advances in Therapy
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    ABSTRACT: The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in September 2006 has markedly reduced the burden of invasive pneumococcal disease (IPD) including meningitis in England and Wales. This study examined changes in the molecular epidemiology of pneumococcal isolates causing meningitis during July 2004-June 2009. The Health Protection Agency conducts enhanced pneumococcal surveillance in England and Wales. In addition to serotyping, pneumococcal isolates causing meningitis were genotyped by Multi Locus Sequence Typing (MLST). A total of 1,030 isolates were both serotyped and genotyped over the 5 year-period. Fifty-two serotypes, 238 sequence types (STs) and 87 clonal complexes were identified, with no significant difference in the yearly Simpson's Diversity Index (range, 0.974-0.984). STs commonly associated with PCV7 serotypes declined following PCV implementation, with a proportionally greater decline in ST124 (commonly associated with serotype 14). No other ST showed significant changes in distribution, even within individual serotypes. Replacement disease following PCV7 introduction was mainly due to serotypes 1, 3, 7F, 19A, 22F and 33F through clonal expansion. A single instance of possible capsule switching was identified where one ST4327 clone expressed a 14 capsule in 2005 and a 28A capsule in 2009. In 2008-09, ST191 (7F) became the most prevalent clone causing meningitis (10.3%). Case fatality (145/1,030; 14.1%) was high across all age groups and serotype groups. Thus, the introduction of PCV7 resulted in an increase in non-PCV7 serotypes, including some not covered by the 13-valent vaccine such as serotypes 22F and 33F, emphasising the importance of long-term epidemiological and molecular surveillance.
    Full-text · Article · Dec 2012 · Journal of clinical microbiology
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