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. 2023 Dec 15;19(3):2279394.
doi: 10.1080/21645515.2023.2279394. Epub 2023 Nov 28.

Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature

Stuti Arya  1 , Nicholas Norton  2 , Puneet Kaushik  1 , Agnes Brandtmüller  3 , Eleana Tsoumani  4
Affiliations

Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature

Stuti Arya et al. Hum Vaccin Immunother. .

Abstract

Despite widespread use of pneumococcal vaccines throughout Europe, the burden of pneumococcal disease (PD) in adults is considerable. To mitigate this burden, National Immunization Technical Advisory Groups (NITAGs) and Health Technology Assessment (HTA) agencies assess the value of different vaccine schedules for protecting against PD. The aim of this review was to assess the evidence and rationales used by NITAGs/HTA agencies, when considering recent changes to National Immunization Programs (NIPs) for adults, and how identified changes affected vaccine coverage rates (VCRs). A systematic review was conducted of published literature from PubMed® and Embase®, and gray literature from HTA/NITAG websites from the last 5 y, covering 31 European countries. Evidence related to NIP recommendations, epidemiology (invasive PD, pneumonia), health economic assessments and VCRs were collected and synthesized. Eighty-four records providing data for 26 countries were identified. Of these, eight described explicit changes to NIPs for adults in seven countries. Despite data gaps, some trends were observed; first, there appears to be a convergence of NIP recommendations in many countries toward sequential vaccination, with a pneumococcal conjugate vaccine (PCV), followed by pneumococcal polysaccharide vaccine 23. Second, reducing economic or healthcare burden were common rationales for implementing changes. Third, most health economic analyses assessing higher-valency PCVs for adults found its inclusion in NIPs cost-effective. Finally, higher coverage rates were seen in most cases where countries had expanded their NIPs to cover at-risk populations. The findings can encourage agencies to improve surveillance systems and work to reach the NIP's target populations more effectively.

Keywords: NITAG; PCV; adults; national immunization program; pneumococcal vaccine; recommendation; vaccine coverage rates.

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Conflict of interest statement

AB and ET are employees of MSD. SA, NN, and PK are current employees of Quantify Research, which received consulting fees from MSD to support the preparation and development of the study and manuscript. The authors report no other conflicts of interest in this work.

Figures

Figure 1.
Figure 1.
Recommended pneumococcal vaccinations for adults in 2022, by country (ECDC).
Figure 2.
Figure 2.
PRIMSA flow chart depicting the record selection process.
Figure 3.
Figure 3.
Number of records per country providing a recommendation, per pneumococcal vaccination (as of 2022).
See this image and copyright information in PMC

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