Impact of 13-pneumococcal conjugate vaccine among adults: a systematic review and meta-analysis.

TitleImpact of 13-pneumococcal conjugate vaccine among adults: a systematic review and meta-analysis.
Publication TypeJournal Article
Year of Publication2018
AuthorsVadlamudi NKhatri, Chen A, Marra F
JournalClin Infect Dis
Date Published10/2018
ISSN1537-6591
Abstract

BACKGROUND: A notable reduction of pneumococcal disease burden among adults was observed after introduction of 7 valent- pneumococcal conjugate vaccine in childhood immunization programs. In 2010, 13 valent-pneumococcal conjugate vaccine (PCV13) replaced PCV7 in many jurisdictions; a comparative assessment of PCV13's impact has not yet been performed.

OBJECTIVE: To summarize available data and assess the change in the incidence of invasive pneumococcal disease (IPD) in adults after the introduction of PCV13 in childhood immunization programs.

METHODS: We conducted a systematic literature search from January 1946 to May 2017 in Cochrane, Embase, Medline and PubMed. We included randomized controlled trials (RCT) and observational studies (OBS) that reported the incidence of IPD, non-invasive pneumococcal disease, hospitalizations, and mortality in adults for the periods before and after the introduction of PCV13. Incidence rate ratio (IRR) were pooled across studies using restricted maximum likelihood random-effects models.

RESULTS: We identified 3306 records (N=29 OBS studies and N=2,033,961 cases). Significantly lower IPD rates were seen after introduction of PCV13 in adults aged <65 years (IRR 0.78; 95%CI: 0.72-0.85) and those aged >65 years (IRR 0.86; 95%CI: 0.81-0.91). Lower rates of IPD were seen with PCV7 (IRR 0.45; 95%CI: 0.38-0.54) and PCV13 serotypes (IRR 0.60; 95%CI: 0.54-0.68). A significantly higher IRR of 1.10 (95%CI: 1.04-1.17) for non-vaccine serotypes was observed, especially among those 65 years and older (IRR 1.20; 95%CI: 1.11-1.29).

CONCLUSIONS: PCV13 use in children had a moderate impact on reducing overall and vaccine-type IPD but there was a significant increase in non-vaccine type IPD among adults, especially over 65 years.

DOI10.1093/cid/ciy872
Alternate JournalClin. Infect. Dis.
PubMed ID30312379