Abstract
The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA) evaluated older adult pneumococcal vaccination and was one of the largest vaccine clinical trials ever conducted. Among older adults aged ≥65 years, the trial established 13-valent pneumococcal conjugate vaccine (PCV13) efficacy in preventing first episodes of bacteremic and nonbacteremic pneumococcal vaccine serotype (VT) community acquired pneumonia (CAP), and of vaccine serotype invasive pneumococcal disease (VT-IPD). Since the publication of the original trial results, 15 additional publications have extended the analyses. In this review, we summarize and integrate the full body of evidence generated by these studies, contextualize the results in light of their public health relevance, and discuss their implications for the assessment of current and future adult pneumococcal vaccination. This accumulating evidence has helped to better understand PCV13 efficacy, serotype-specific efficacy, efficacy in subgroups, the interpretation of immunogenicity data, and the public health value of adult PCV vaccination.
Highlights
Streptococcus pneumoniae is an important cause of morbidity and mortality globally, in both children and adults, and accounts each year for an estimated 660,000 lower respiratory tract infection (LRTI)-related deaths and 9600 deaths due to meningitis in adults aged≥50 years of age globally [1,2]
NB/NI vaccine serotype (VT) community acquired pneumonia (CAP) was reported in 33 PCV13 group participants and 60 placebo group participants
When using self-reported comorbidity status at study entry, both publications reported identical point estimates against VT CAP, including 40.3% among study subjects with at-risk conditions versus 66.7% among subjects without risk conditions
Summary
Streptococcus pneumoniae is an important cause of morbidity and mortality globally, in both children and adults, and accounts each year for an estimated 660,000 lower respiratory tract infection (LRTI)-related deaths and 9600 deaths due to meningitis in adults aged. ≥50 years of age globally [1,2]. S. pneumoniae has 100 distinct serotypes that differ in their propensity to cause disease overall, as well as their association with case fatality, and antimicrobial resistance [5,6]. Adult pneumococcal disease incidence increases substantially after 50 years of age, as does associated mortality. In addition to age as a risk factor, smoking and certain medical conditions, including immunocompromising conditions, increase the risk for pneumococcal infection and are associated with potentially increased morbidity and mortality [7,8,9].
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