Pneumococcal conjugate vaccine against serotype 3 pneumococcal pneumonia in adults: A systematic review and pooled analysis

• Published in: Vaccine Vol. 37; no. 43; pp. 6310 - 6316
• Main Authors: McLaughlin, John M., Jiang, Qin, Gessner, Bradford D., Swerdlow, David L., Sings, Heather L., Isturiz, Raul E., Jodar, Luis
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 08.10.2019; Elsevier Limited
• Subjects: 13-valent pneumococcal conjugate vaccine (PCV13); Adults; Allergy and Immunology; Argentina; case-control studies; Community-acquired pneumonia (CAP); Conjugates; Effectiveness; Efficacy; Elderly; Epidemiology; Heterogeneity; Immunization; Kentucky; Literature reviews; Netherlands; Pneumonia; Pooled analysis; Population decline; randomized clinical trials; Serotype 3; serotypes; Streptococcus infections; Streptococcus pneumoniae; Studies; Systematic review; Vaccine efficacy; Vaccines; United States > US; Argentina; Netherlands; Kentucky; PCV; PCV13; RCT; Effectiveness; CDC; Serotype 3; Pooled analysis; PCV10; CI; Efficacy; MeSH; CAPiTA; TND; mITT; VE; CAP; 13-valent pneumococcal conjugate vaccine (PCV13); Adults; Community-acquired pneumonia (CAP); IPD; Elderly; ECDC; invasive pneumococcal disease; Centers for Disease Control and Prevention; test-negative design; Medical Subject Headings; vaccine efficacy or effectiveness; pneumococcal conjugate vaccine; European Centers for Disease Control; community-acquired pneumonia; Community-acquired Pneumonia Immunization Trial in Adults; randomized controlled trial; 10-valent pneumococcal conjugate vaccine; 13-valent pneumococcal conjugate vaccine; confidence interval; modified intent-to-treat
• ISSN: 0264-410X; 1873-2518; 1873-2518
• DOI: 10.1016/j.vaccine.2019.08.059

Serotype 3 pneumococcal disease has not substantially declined at the population level after the routine introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into pediatric immunization programs across the globe. This epidemiological finding has generated debate regarding the effectiveness of PCV13 against serotype 3 disease. Evaluating PCV13 effectiveness against serotype 3 is especially critical in adults, where serotype 3 makes up an important amount of remaining pneumococcal disease. We performed a systematic review of the published literature to assess the direct effectiveness of PCV13 against serotype 3 community-acquired pneumonia (CAP) among adults. We then estimated overall vaccine effectiveness (VE) using a pooled analysis of the individual-level, raw data. Two published studies met inclusion criteria. One was a randomized controlled trial conducted in the Netherlands and published in 2014. The other was a recently-published case-control study conducted in Louisville, Kentucky that used a test-negative design (TND). We also identified a third TND study conducted in Argentina that was recently presented as a conference abstract but is not yet published. All three studies were conducted in adults aged ≥65 years. PCV13 VE against serotype 3 hospitalized CAP was 52.5% (95%CI: 6.2–75.9%) from the pooled analysis of individual-level data from all three studies. Results were similar if the unpublished estimate was excluded (serotype 3 VE = 53.6% [95%CI: 6.7–76.9%]). No heterogeneity was observed. Currently-available evidence, although limited to three studies, suggests that PCV13 provides direct protection against serotype 3 hospitalized CAP in adults aged ≥65 years.