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Is It Time To Review The Vaccination Strategy To Protect Adults Against Invasive Pneumococcal Disease?

M Corcoran1, J Mereckiene2, S Murchan2

  • 1The Irish Pneumococcal Reference Laboratory, Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children’s University Hospital, Temple Street, Dublin 1, Ireland.

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Pneumococcal conjugate vaccines (PCVs) reduced targeted serotypes in older adults. However, non-vaccine types increased, indicating serotype replacement. Increased PPV23 use may mitigate this.

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Area of Science:

  • Epidemiology
  • Immunology
  • Public Health

Background:

  • Pneumococcal conjugate vaccines (PCVs) have decreased invasive pneumococcal disease (IPD) by targeting prevalent serotypes.
  • The impact of childhood PCV7 and PCV13 programs on IPD in older adults requires ongoing assessment.

Purpose of the Study:

  • To evaluate the effect of PCV7 and PCV13 introduction on serotype-specific IPD incidence in adults aged 65 years and older.
  • To identify shifts in circulating pneumococcal serotypes following widespread childhood vaccination.

Main Methods:

  • Comparative analysis of serotype-specific IPD incidence rates in adults ≥65 years.
  • Data collected from the 2007/08 to 2016/17 seasons.
  • Incidence rate ratios (IRRs) were calculated to compare serotype trends.

Main Results:

  • Significant decline observed in PCV7 serotypes (85% decrease) and a non-significant decrease in PCV13-unique serotypes (9%).
  • Substantial increases noted in serotypes covered by the 23-valent polysaccharide vaccine but not PCV13 (PPV23-PCV13) and non-vaccine types (NVTs).
  • Incidence rate ratios indicated a 2.57-fold increase for PPV23-PCV13 serotypes and a 3.33-fold increase for NVTs.

Conclusions:

  • Childhood PCV7 and PCV13 vaccination programs have led to serotype replacement in older adults, with a decrease in vaccine-targeted serotypes and an increase in non-vaccine serotypes.
  • The rise in PPV23-PCV13 and NVT serotypes highlights the need for strategies to address evolving IPD epidemiology.
  • Increased uptake of the 23-valent polysaccharide vaccine (PPV23) may be a viable approach to reduce the overall burden of IPD in this population.