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- Title
Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design.
- Authors
McLaughlin, John M; Jiang, Qin; Isturiz, Raul E; Sings, Heather L; Swerdlow, David L; Gessner, Bradford D; Carrico, Ruth M; Peyrani, Paula; Wiemken, Timothy L; Mattingly, William A
- Abstract
Background Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Methods Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Results Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P =.02) and overweight or obese (41.2% vs 58.6%, P =.01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%−91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%−73.3%). Conclusions Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.
- Subjects
UNITED States; PNEUMOCOCCAL vaccines; HOSPITAL care of older people; CONFIDENCE intervals; IMMUNE response; IMMUNIZATION; IMMUNOCOMPETENT cells; MEDICAL protocols; HEALTH outcome assessment; VACCINATION; IMMUNIZATION of older people; COMMUNITY-acquired pneumonia; SEROTYPES; DESCRIPTIVE statistics; OLD age; PSYCHOLOGY; PREVENTION; HISTORY; VACCINES
- Publication
Clinical Infectious Diseases, 2018, Vol 67, Issue 10, p1498
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy312