Journal article
Comparative Effectiveness of Pneumococcal Vaccination Strategies to Prevent Invasive Pneumococcal Disease: A Population-Based Cohort Study at the Veterans Health Administration in the United States
Clinical microbiology and infection, Vol.31(3), pp.402-407
03/2025
DOI: 10.1016/j.cmi.2024.09.006
PMID: 39299558
Abstract
Comparative effectiveness of pneumococcal 13-valent conjugate vaccine (PCV13), 23-valent polysaccharide vaccine (PPSV23), and their combinations for adults in preventing invasive pneumococcal disease (IPD) has yet to be thoroughly investigated. We aimed to estimate the comparative effectiveness of preventing IPD, using population-based data from the Veterans Health Administration (VHA) in the United States (US).
We included all patients who were between 65 and 74 years, had established primary care within VHA between 2005 and 2021, and had not received any prior pneumococcal vaccination. We measured time-to-event from cohort enrollment to the onset of IPD, considering death a competing risk event, and used Cox regression models to estimate cause-specific hazards. PCV13 only, PPSV23 only, PCV13 after PPSV23, and PPSV23 after PCV13 were incorporated into models as time-dependent covariates. Patient demographics and comorbidities were also included in the model.
3,044,067 patients were enrolled in the cohort, with 863,958 deaths (28.4%) and 1,731 cases of IPD (0.06%) during the study period. The overall incidence rate of IPD in this population was 5.36 per 100,000 patient-years. 921,070 patients (30.3%) received at least one dose of effective pneumococcal vaccine. In multivariate analysis adjusted for comorbidities, PCV13 alone was not associated with the reduced risk of IPD, while PPSV23 had protective association with IPD incidence (adjusted hazard ratio [aHR]: 0.70 [95% confidence interval (CI): 0.59-0.83]). When combined, PCV13 followed by PPSV23 had a stronger protective association (aHR: 0.54 [0.36-0.83]) compared to PPSV23 followed by PCV13 (aHR: 0.73 [0.58-0.91]).
In this large cohort study at the VHA, the combination of PCV13 and PPSV23, particularly PCV13 followed by PPSV23, was associated with a lower risk of IPD, indicating additional benefits in combined vaccinations with potential importance in vaccination order. Further studies are needed to evaluate the effect of newer pneumococcal vaccines.
Details
- Title: Subtitle
- Comparative Effectiveness of Pneumococcal Vaccination Strategies to Prevent Invasive Pneumococcal Disease: A Population-Based Cohort Study at the Veterans Health Administration in the United States
- Creators
- Shinya Hasegawa - University of IowaMichael P. Jones - University of IowaSatoshi Kakiuchi - Nagasaki University HospitalEli N. Perencevich - University of IowaMichihiko Goto - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Clinical microbiology and infection, Vol.31(3), pp.402-407
- DOI
- 10.1016/j.cmi.2024.09.006
- PMID
- 39299558
- NLM abbreviation
- Clin Microbiol Infect
- ISSN
- 1198-743X
- eISSN
- 1469-0691
- Publisher
- Elsevier Ltd
- Grant note
- Merck Co, Inc.
This work was funded by Merck & Co, Inc. through Merck Investigator Study Program (PI: M.G.) . The funding source had no role in data collection, analysis, interpretation, writing, and the decision to submit for publication.
- Language
- English
- Electronic publication date
- 09/17/2024
- Date published
- 03/2025
- Academic Unit
- Statistics and Actuarial Science; Epidemiology; Biostatistics; Center for Social Science Innovation; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984704841202771
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