Real-world effectiveness of pneumococcal vaccination in older adults: Cohort study using the UK Clinical Practice Research Datalink.
Aged
Anti-Bacterial Agents
Cohort Studies
Community-Acquired Infections
/ prevention & control
Humans
Pneumococcal Infections
/ prevention & control
Pneumococcal Vaccines
/ therapeutic use
Pneumonia
Pneumonia, Pneumococcal
/ prevention & control
Streptococcus pneumoniae
United Kingdom
/ epidemiology
Vaccination
/ methods
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
30
07
2021
accepted:
21
09
2022
entrez:
13
10
2022
pubmed:
14
10
2022
medline:
18
10
2022
Statut:
epublish
Résumé
The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for UK older adults, but how age moderates effectiveness is unclear. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 36227889
doi: 10.1371/journal.pone.0275642
pii: PONE-D-21-24738
pmc: PMC9560513
doi:
Substances chimiques
Anti-Bacterial Agents
0
Pneumococcal Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0275642Subventions
Organisme : Department of Health
ID : IS-SPH-0211-10100 - SPHR-SWP-AWP-PR2
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0902158
Pays : United Kingdom
Organisme : Department of Health
ID : NIHR301445
Pays : United Kingdom
Déclaration de conflit d'intérêts
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.
Références
J Infect Dis. 2018 May 5;217(11):1718-1727
pubmed: 29452380
BMC Infect Dis. 2021 Jan 10;21(1):45
pubmed: 33423657
N Engl J Med. 1980 Sep 4;303(10):549-52
pubmed: 6995835
Pharmacoepidemiol Drug Saf. 2012 May;21 Suppl 2:60-8
pubmed: 22552981
Int J Epidemiol. 2015 Jun;44(3):827-36
pubmed: 26050254
Pharmacoepidemiol Drug Saf. 2013 Jan;22(1):86-97
pubmed: 23070833
Pharmacoepidemiol Drug Saf. 2008 Jul;17(7):661-70
pubmed: 18327857
Lancet Infect Dis. 2017 Mar;17(3):313-321
pubmed: 28126327
J Infect Dis. 2017 Aug 15;216(4):399-401
pubmed: 28931239
PLoS One. 2017 Jan 6;12(1):e0169368
pubmed: 28061505
Am J Epidemiol. 2016 Sep 1;184(5):345-53
pubmed: 27587721
PLoS One. 2013 Sep 11;8(9):e75131
pubmed: 24040394
PLoS One. 2016 Jan 13;11(1):e0146338
pubmed: 26761816
Epidemiol Infect. 2008 Feb;136(2):232-40
pubmed: 17445319
N Engl J Med. 2015 Mar 19;372(12):1114-25
pubmed: 25785969
Geriatrics (Basel). 2021 Feb 04;6(1):
pubmed: 33557406
J Clin Epidemiol. 2022 Jul 8;151:122-131
pubmed: 35817230
EClinicalMedicine. 2019 Jan 02;6:42-50
pubmed: 31193709
Vaccine. 2016 Mar 18;34(13):1540-1550
pubmed: 26899372
Thorax. 2012 Jan;67(1):71-9
pubmed: 20729232
Vaccine. 2016 Mar 18;34(13):1496-1503
pubmed: 26899376
Biometrics. 2013 Dec;69(4):850-60
pubmed: 24224574
Lancet Infect Dis. 2017 Mar;17(3):244-246
pubmed: 28126328
Int J Clin Pharm. 2016 Jun;38(3):714-23
pubmed: 27091131
J Clin Epidemiol. 2017 Jul;87:23-34
pubmed: 28460857
Pharmacoepidemiol Drug Saf. 2008 Jul;17(7):671-85
pubmed: 18327852
PLoS One. 2021 Jan 29;16(1):e0246156
pubmed: 33513169
Epidemiology. 2000 Sep;11(5):550-60
pubmed: 10955408
PLoS Med. 2020 Oct 23;17(10):e1003326
pubmed: 33095759
Vaccine. 2016 Jul 25;34(34):4083-4084
pubmed: 27329185
Vaccine. 2016 Jul 19;34(33):3875-81
pubmed: 27265450
Pharmacoepidemiol Drug Saf. 2020 Oct;29(10):1219-1227
pubmed: 32929830
J Am Geriatr Soc. 2018 Jul;66(7):1332-1338
pubmed: 29676433
Stat Med. 2013 Jul 20;32(16):2837-49
pubmed: 23239115
Br J Clin Pharmacol. 1998 May;45(5):419-25
pubmed: 9643612
Cochrane Database Syst Rev. 2013 Jan 31;(1):CD000422
pubmed: 23440780
Stat Med. 2016 Dec 10;35(28):5149-5169
pubmed: 27477530
BMJ. 2009 Jan 27;338:b81
pubmed: 19174434
Vaccine. 2016 Sep 7;34(39):4645-6
pubmed: 27578296