Clinical effectiveness of 13-valent and 23-valent pneumococcal vaccination among adults with immunocompromising conditions.

Abstract

<b>Background:</b> Clinical benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) or the 23-valent polysaccharide vaccine (PPsV23) are controversial. We investigated clinical effectiveness for both PPsV23/PCV13 against pneumonia in immunocompromised adults. <b>Methods:</b> Cohort study involving 203,447 Catalonian Adults (aged ≥50 years) with potential immunocompromising conditions (i.e, aspleny, immunodeficiency/HIV infection, severe renal disease, solid or haemathological neoplasia and/or immunosupresive treatment), who were followed between 01/01/2017-31/12/2017 (Funding: PERIS SLT002/16/00063). Primary outcomes were hospitalisation from pneumococcal or all-cause pneumonia and main explanatory variable was PCV13/PPsV23 status. Multivariable Cox regression was used to estimate vaccination effectiveness adjusting for age/sex and comorbidities. <b>Results:</b> Cohort members were followed for 192,716 person-years (7,248 PCV13-vaccinated and 115,574 PPsV23-vaccinated), observing 480 pneumococcal pneumonias (36 in PCV13-, 364 in PPsV23-vaccinated) and 3622 all-cause pneumonias (264 in PCV13-, 2817 in PPsV23-vaccinated). Pneumococcal vaccination did not significantly alter the risk of pneumococcal pneumonia (hazard ratio [HR] for PCV13: 1.43, 95% CI: 0.99-2.06, p=0.057; HR for PPsV23: 1.27, 95% CI: 0.99-1.64, p=0.065) but it appeared significantly associated with an increasing risk of all-cause pneumonia (HR for PCV13: 1.34, 95% CI: 1.17-1.54, p&lt;0.001; HR for PPsV23: 1.15, 95% CI: 1.05-1.27, p=0.004). <b>Conclusion:</b> Data does not support clinical benefits from pneumococcal vaccination (nor PCV13 neither PPsV23) in preventing pneumonia among immunocompromised subjects.