Direct effectiveness of pneumococcal polysaccharide vaccine against invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia in elderly population in the era of pneumococcal conjugate vaccine

A case-control study

Jong Hun Kim, Byung-Chul Chun, Joon-Young Song, Hyo Youl Kim, In Gyu Bae, Dong Min Kim, Young Hwa Choi, Yoon Hee Jun, Wonseok Choi, Seong Hee Kang, Hyun Hee Kwon, Hye Won Jeong, Sae Yoon Kee, Jian Hur, Jin Won Chung, Young Kyung Yoon, Jang Wook Sohn, Kyung Sook Yang, Min Ja Kim

Research output: Contribution to journalArticle

Abstract

Background: While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population. Methods: For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100. Results: We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5% [95% confidence interval (CI) −5.8%–51.6%] and against NBPP was 10.2% (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65–74 years, PPV23 was protective against IPD [effectiveness 57.4% (19.4–77.5)] and against NBPP [effectiveness 35.0% (2.3–56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6% (27.6–98.8) for PPV23-unique serotypes and 81.3% (38.6–94.3) for PPV23 serotypes excluding serotype 3. Conclusions: This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP.

Original languageEnglish
Pages (from-to)2797-2804
Number of pages8
JournalVaccine
Volume37
Issue number21
DOIs
Publication statusPublished - 2019 May 9

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Pneumococcal Pneumonia
Conjugate Vaccines
Pneumococcal Vaccines
case-control studies
pneumonia
Case-Control Studies
serotypes
polysaccharides
vaccines
Population
conjugated proteins
Immunization Programs
childhood
Vaccines
immunization
South Korea
Republic of Korea
odds ratio
confidence interval
Serogroup

Keywords

  • 23-valent pneumococcal vaccine
  • Case-control study
  • Effectiveness
  • Pneumococcal infections
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Direct effectiveness of pneumococcal polysaccharide vaccine against invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia in elderly population in the era of pneumococcal conjugate vaccine : A case-control study. / Kim, Jong Hun; Chun, Byung-Chul; Song, Joon-Young; Kim, Hyo Youl; Bae, In Gyu; Kim, Dong Min; Choi, Young Hwa; Jun, Yoon Hee; Choi, Wonseok; Kang, Seong Hee; Kwon, Hyun Hee; Jeong, Hye Won; Kee, Sae Yoon; Hur, Jian; Chung, Jin Won; Yoon, Young Kyung; Sohn, Jang Wook; Yang, Kyung Sook; Kim, Min Ja.

In: Vaccine, Vol. 37, No. 21, 09.05.2019, p. 2797-2804.

Research output: Contribution to journalArticle

Kim, Jong Hun ; Chun, Byung-Chul ; Song, Joon-Young ; Kim, Hyo Youl ; Bae, In Gyu ; Kim, Dong Min ; Choi, Young Hwa ; Jun, Yoon Hee ; Choi, Wonseok ; Kang, Seong Hee ; Kwon, Hyun Hee ; Jeong, Hye Won ; Kee, Sae Yoon ; Hur, Jian ; Chung, Jin Won ; Yoon, Young Kyung ; Sohn, Jang Wook ; Yang, Kyung Sook ; Kim, Min Ja. / Direct effectiveness of pneumococcal polysaccharide vaccine against invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia in elderly population in the era of pneumococcal conjugate vaccine : A case-control study. In: Vaccine. 2019 ; Vol. 37, No. 21. pp. 2797-2804.
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abstract = "Background: While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population. Methods: For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100. Results: We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5{\%} [95{\%} confidence interval (CI) −5.8{\%}–51.6{\%}] and against NBPP was 10.2{\%} (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65–74 years, PPV23 was protective against IPD [effectiveness 57.4{\%} (19.4–77.5)] and against NBPP [effectiveness 35.0{\%} (2.3–56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6{\%} (27.6–98.8) for PPV23-unique serotypes and 81.3{\%} (38.6–94.3) for PPV23 serotypes excluding serotype 3. Conclusions: This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP.",
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author = "Kim, {Jong Hun} and Byung-Chul Chun and Joon-Young Song and Kim, {Hyo Youl} and Bae, {In Gyu} and Kim, {Dong Min} and Choi, {Young Hwa} and Jun, {Yoon Hee} and Wonseok Choi and Kang, {Seong Hee} and Kwon, {Hyun Hee} and Jeong, {Hye Won} and Kee, {Sae Yoon} and Jian Hur and Chung, {Jin Won} and Yoon, {Young Kyung} and Sohn, {Jang Wook} and Yang, {Kyung Sook} and Kim, {Min Ja}",
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TY - JOUR

T1 - Direct effectiveness of pneumococcal polysaccharide vaccine against invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia in elderly population in the era of pneumococcal conjugate vaccine

T2 - A case-control study

AU - Kim, Jong Hun

AU - Chun, Byung-Chul

AU - Song, Joon-Young

AU - Kim, Hyo Youl

AU - Bae, In Gyu

AU - Kim, Dong Min

AU - Choi, Young Hwa

AU - Jun, Yoon Hee

AU - Choi, Wonseok

AU - Kang, Seong Hee

AU - Kwon, Hyun Hee

AU - Jeong, Hye Won

AU - Kee, Sae Yoon

AU - Hur, Jian

AU - Chung, Jin Won

AU - Yoon, Young Kyung

AU - Sohn, Jang Wook

AU - Yang, Kyung Sook

AU - Kim, Min Ja

PY - 2019/5/9

Y1 - 2019/5/9

N2 - Background: While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population. Methods: For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100. Results: We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5% [95% confidence interval (CI) −5.8%–51.6%] and against NBPP was 10.2% (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65–74 years, PPV23 was protective against IPD [effectiveness 57.4% (19.4–77.5)] and against NBPP [effectiveness 35.0% (2.3–56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6% (27.6–98.8) for PPV23-unique serotypes and 81.3% (38.6–94.3) for PPV23 serotypes excluding serotype 3. Conclusions: This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP.

AB - Background: While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population. Methods: For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100. Results: We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5% [95% confidence interval (CI) −5.8%–51.6%] and against NBPP was 10.2% (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65–74 years, PPV23 was protective against IPD [effectiveness 57.4% (19.4–77.5)] and against NBPP [effectiveness 35.0% (2.3–56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6% (27.6–98.8) for PPV23-unique serotypes and 81.3% (38.6–94.3) for PPV23 serotypes excluding serotype 3. Conclusions: This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP.

KW - 23-valent pneumococcal vaccine

KW - Case-control study

KW - Effectiveness

KW - Pneumococcal infections

KW - Streptococcus pneumoniae

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JO - Vaccine

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