Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 13;17(10):e0275642.
doi: 10.1371/journal.pone.0275642. eCollection 2022.

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

Adam J Streeter  1   2   3 , Lauren R Rodgers  3 , Jane Masoli  3 , Nan X Lin  4 , Alessandro Blé  3 , Willie Hamilton  3 , William E Henley  3
Affiliations

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

Adam J Streeter et al. PLoS One. .

Erratum in

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

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.

Figures

Fig 1
Fig 1. Diagram outlining recruitment of the three cohorts coinciding with stepped implementation of the policy to offer the vaccine to older adults, beginning with ≥80y in 2003, then additionally the ≥75y age group and finally all adults aged ≥65y.
Fig 2
Fig 2. Schematic of the study design.
Patients vaccinated during a 1y recruitment window are selected and matched to controls by age, gender and general practice. Index dates of controls are mapped from the vaccination dates of vaccinees. Event times are compared for vaccinated and control patients during a 2y study period and a 2y prior period. The start of the prior period precedes recruitment by exactly 2y. Survival times may end with an event or be censored before the end of either period.
Fig 3
Fig 3. Flowchart for the three cohorts 2003–2005.
Fig 4
Fig 4. Pairwise-adjusted hazard ratios of vaccination for each annual cohort (2003–005) by sub-groups of age (65 to 74y –light grey circle; 75 to 79y –mid-grey triangles; 80+y–black squares.
See this image and copyright information in PMC

References

    1. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012;67: 71–9. doi: 10.1136/thx.2009.129502 - DOI - PubMed
    1. Thomas RE. Pneumococcal pneumonia and invasive pneumococcal disease in those 65 and older: Rates of detection, risk factors, vaccine effectiveness, hospitalisation and mortality. Geriatrics (Switzerland). Multidisciplinary Digital Publishing Institute; 2021. pp. 1–17. doi: 10.3390/geriatrics6010013 - DOI - PMC - PubMed
    1. Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane database Syst Rev. 2013;1: CD000422. doi: 10.1002/14651858.CD000422.pub3 - DOI - PMC - PubMed
    1. Diao W-Q, Shen N, Yu P-X, Liu B-B, He B. Efficacy of 23-valent pneumococcal polysaccharide vaccine in preventing community-acquired pneumonia among immunocompetent adults: A systematic review and meta-analysis of randomized trials. Vaccine. 2016;34: 1496–503. doi: 10.1016/j.vaccine.2016.02.023 - DOI - PubMed
    1. Kraicer-Melamed H, O’Donnell S, Quach C. The effectiveness of pneumococcal polysaccharide vaccine 23 (PPV23) in the general population of 50 years of age and older: A systematic review and meta-analysis. Vaccine. 2016;34: 1540–1550. doi: 10.1016/j.vaccine.2016.02.024 - DOI - PubMed

Publication types

MeSH terms

Substances