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PCV13 Use in Older Adults & Hospitalizations for Pneumonia

Medicare beneficiaries aged 65 years or older had lower hospitalization rates for pneumonia when vaccinated with the 13-valent pneumococcal conjugate vaccine (PCV13), a cohort study shows. “Increased PCV13 coverage and use of recently approved higher-valent pneumococcal conjugate vaccines may avert additional pneumonia hospitalizations in adults,” the authors conclude.

Included in the analysis were older adults enrolled continuously in Parts A and B from Sept. 1, 2014, through Dec. 31, 2017, and residing within the 50 states or the District of Columbia. Based on the use of PCV13 at least 14 days before pneumonia hospitalizations, the investigators calculated the incidence rate ratio (IRR), the number of pneumonia hospitalizations averted through PCV13 use, and vaccine effectiveness (VE) based on the adjusted IRR.

“At the end of follow-up (December 2017), 24 ,121, 625 beneficiaries (13,593,975 women [56.4%]; 418,005 [1.7%] Asian, 1,750,807 [4.8%] Black, 338,044 [1.4%] Hispanic, 111,508 [0.5%] Native American, and 20,700,948 [85.8%] White individuals) were in the cohort; 4,936,185 (20.5%) had received PCV13 only, and 10,646,220 (79.5%) had not received any pneumococcal vaccines,” the researchers report. “More than half of the beneficiaries in the cohort were younger than 75 years, White, and had either immunocompromising or chronic medical conditions. Coverage with PCV13 increased from 0.8% (September 2014) to 41.5% (December 2017). The VE for PCV13 was estimated at 6.7% (95% CI, 5.9%-7.5%) for pneumonia, 4.7% (95% CI, 3.9%-5.6%) for [non–healthcare–associated (non-HA)] pneumonia, and 5.8% (95% CI, 2.6%-8.9%) for [lobar pneumonia (LP)]. From September 2014 through December 2017, an estimated 35,127 pneumonia (95% CI, 33,011-37,270), 24,643 non-HA pneumonia (95% CI, 22,761-26,552), and 1294 LP (95% CI, 797–1819) hospitalizations were averted through PCV13 use.”

Editorial: “With [this study], there is now an increasing body of evidence that use of PCV13 in low-risk and high-risk adults 65 years or older may have important benefits on clinically relevant outcomes beyond etiologically confirmed vaccine-type [invasive pneumococcal disease],” editorialists write. “Based on these emerging data, we are hopeful that the recently streamlined ACIP routine recommendation for the higher-valent pneumococcal conjugate vaccines in all adults 65 years or older will increase vaccination rates in this population and further reduce pneumonia hospitalizations and other serious sequelae. Monitoring clinically relevant disease end points, such as hospitalization due to all-cause pneumonia, will be critical when assessing the effectiveness of higher-valent PCV vaccines.”

Source: JAMA Internal Medicine