Comparative effectiveness of individual pneumococcal vaccines with dual pneumococcal vaccination in older United States Veterans.

Autor: Narsingam S; Department of Medicine, Eastern Maine Medical Center, Bangor, ME, United States; Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Department of Pulmonary Medicine, VA Medical Center, White River Junction, VT, United States. Electronic address: narsingam.sp@gmail.com., Munson J; Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States., Drescher F; Department of Pulmonary Medicine, VA Medical Center, White River Junction, VT, United States.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2022 Aug 19; Vol. 40 (35), pp. 5223-5228. Date of Electronic Publication: 2022 Aug 01.
DOI: 10.1016/j.vaccine.2022.07.035
Abstrakt: Introduction: Pneumococcal vaccination recommendations are constantly evolving. Recent pneumococcal vaccination guidelines have been updated to recommend pneumococcal conjugate vaccines in older adults. However, the clinical benefits of protein conjugate vaccine (PCV 13), pneumococcal polysaccharide vaccine (PPSV 23) and dual vaccination when compared to each other remain unclear.
Methods: A retrospective cohort study conducted between 2014 and 2016 conducted at the Veterans Health administration (VHA) (N = 1,277,575). Primary outcomes were pneumococcal pneumonia and pneumococcal meningitis. Secondary outcomes were "other" pneumonia and "other" meningitis. "Other" referred to episodes of pneumonia and meningitis without an identified etiological agent.
Results: PCV 13 was associated with decreased risk of pneumococcal pneumonia (Adjusted HR 0.69; 95 % CI 0.51 to 0.93) and "other" pneumonia (Adjusted HR 0.74; 95 % CI 0.64 to 0.86) when compared to PPSV 23. No significant difference was found between PCV 13 and PPSV 23 in terms of pneumococcal meningitis (Adjusted HR 3.98; 95 % CI 0.74 to 21.32; P = 0.12) and "other" meningitis (Adjusted HR 0.81; 95 % CI 0.33 to 2.03; P = 0.66). Dual vaccination was also associated with a decrease in the rate of pneumococcal pneumonia (Adjusted HR 0.88; 95 % CI 0.77 to 0.99; P = 0.03) and "other" pneumonia (Adjusted HR 0.90; 95 % CI 0.85 to 0.95; P < 0.01) in comparison to PPSV 23.
Conclusions: PCV 13 was associated with a 31% decrease in the rate of pneumococcal pneumonia in comparison to PPSV 23 in older adult Veterans. Our results demonstrating clinical benefit with PCV 13 vaccination are in alignment with the latest pneumococcal vaccination guidelines that recommend routine vaccination with pneumococcal conjugate vaccines in all older adults.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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