Real-world effectiveness of pneumococcal vaccination in older adults: Cohort study using the UK Clinical Practice Research Datalink.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Community-Acquired Infections*/prevention & control ; Pneumococcal Infections*/prevention & control ; Pneumonia* ; Pneumonia, Pneumococcal*/prevention & control; Aged ; Anti-Bacterial Agents ; Cohort Studies ; Humans ; Pneumococcal Vaccines/therapeutic use ; Streptococcus pneumoniae ; United Kingdom/epidemiology ; Vaccination/methods

Background: The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for UK older adults, but how age moderates effectiveness is unclear.
Methods: Three annual cohorts of primary-care patients aged≥65y from the Clinical Practice Research Datalink selected from 2003-5 created a natural experiment (n = 324,804), reflecting the staged introduction of the vaccine. The outcome was symptoms consistent with community-acquired pneumococcal pneumonia (CAP) requiring antibiotics or hospitalisation. We used the prior event rate ratio (PERR) approach to address bias from unmeasured confounders.
Results: Vaccinated patients had higher rates of CAP in the year before vaccination than their controls, indicating the potential for confounding bias. After adjustment for confounding using the prior event rate ratio (PERR) method, PPV23 was estimated to be effective against CAP for two years after vaccination in all age sub-groups with hazard ratios (95% confidence intervals) of 0.86 (0.80 to 0.93), 0.74 (0.65 to 0.85) and 0.65 (0.57 to 0.74) in patients aged 65-74, 75-79 and 80+ respectively in the 2005 cohort. Age moderated the effect of vaccination with predicted risk reductions of 8% at 65y and 29% at 80y.
Conclusions: PPV23 is moderately effective at reducing CAP among UK patients aged≥65y, in the two years after vaccination. Vaccine effectiveness is maintained, and may increase, in the oldest age groups in step with increasing susceptibility to CAP.
Competing Interests: Further to the competing interests section, Alessandro Blé has since joined Glaxo-Smith Kline and so “Alessandro Blé is currently an employee of Glaxo-Smith Kline (GSK) and declares that GSK had neither a role nor influence in the study design, data collection, preparation of the manuscript or decision to publish. The authors have no other potentially competing interests to declare. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Erratum in: PLoS One. 2024 Nov 19;19(11):e0314373. doi: 10.1371/journal.pone.0314373. (PMID: 39561167)

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IS-SPH-0211-10100 - SPHR-SWP-AWP-PR2 United Kingdom DH_ Department of Health; G0902158 United Kingdom MRC_ Medical Research Council; NIHR301445 United Kingdom DH_ Department of Health

0 (Anti-Bacterial Agents)
0 (Pneumococcal Vaccines)

Date Created: 20221013 Date Completed: 20221017 Latest Revision: 20241119

20241119

PMC9560513

10.1371/journal.pone.0275642

36227889