Abstract
Controversy exists regarding the clinical effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for the prevention of serotype-specific community-acquired pneumonia (CAP). The objective of this study was to define the effectiveness of PPSV23 for the prevention of CAP hospitalizations due to vaccine-contained serotypes. This secondary analysis was a nested case–control, test-negative study design of adult patients hospitalized for CAP between 1 June 2014 and 31 March 2017. Cases included patients with CAP due to a S. pneumoniae serotype contained in the PPSV23. Urinary antigen detection of the 23 serotypes was performed. In the study, PPSV23 vaccination alone and no other pneumococcal vaccination was the primary exposure of interest. Vaccine effectiveness was calculated as (1-OR) × 100. Adjusted estimates were obtained from a logistic regression model that controlled for confounding variables. A total of 3686 patients were included in the analysis. The PPSV23 vaccination was documented in 608 (16%) patients, and the PPSV23-serotype CAP was detected in 48 (8%) PPSV23-vaccinated patients and in 288 (9%) non-vaccinated patients. Unadjusted vaccine effectiveness for preventing PPSV23-serotype CAP was 17% (95% CI: −13% to 40%). Adjusted estimates for preventing PPSV23-serotype CAP was 14% (95% CI: −17% to 38%). In this study, PPSV23 vaccination offered no protection against PPSV23-serotype CAP hospitalization in adults. This is the first PPSV23 vaccine effectiveness study from United States that utilized a urinary antigen detection assay as the main method for S. pneumoniae serotyping. This study highlights the need for more effective vaccines in the prevention of hospitalization due to S. pneumoniae CAP.
Highlights
Current data suggests that 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination is effective in preventing invasive pneumococcal disease (IPD) in adults [1–5], with an estimated effectiveness of 60% to 70% reported by the United States
All analyses were performed in R version 4.1.1. p-values were two-sided with statistical significance set at p < 0.05. This was approved by the Institutional Review Board (IRB) at the University of Louisville A
Our study shows that PPSV23 vaccination does not prevent hospitalization due to pneumococcal community-acquired pneumonia (CAP) from vaccine-type serotypes
Summary
In the United States, the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Was approved for use in 1983 for the prevention of pneumococcal disease caused by the. 23 Streptococcus pneumoniae serotypes contained in the vaccine. Current data suggests that PPSV23 vaccination is effective in preventing invasive pneumococcal disease (IPD) in adults [1–5], with an estimated effectiveness of 60% to 70% reported by the United States. Centers for Disease Control and Prevention (CDC) [6]. There is no consensus regarding PPSV23 vaccination for the prevention of hospitalized CAP due to serotypes contained in the PPSV23. The primary challenge with this type of study has been the identification of vaccine-specific serotypes.
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