The impact of 13-valent pneumococcal conjugate vaccination on virus-associated community-acquired pneumonia in elderly

5 years ago

The impact of 13-valent pneumococcal conjugate vaccination on virus-associated community-acquired pneumonia in elderly

Our objective was to evaluate whether vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) prevents the incidence of community-acquired pneumonia (CAP) caused by influenza (Influenza-Associated CAP, IA-CAP) or other respiratory viruses in elderly.

Methods

This analysis was part of the Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA); a double blind, randomized, placebo-controlled trial in 84,496 immunocompetent individuals aged ≥65 years. CAP was defined by clinical and radiological criteria, and oropharyngeal swabs were collected from all subjects referred to a sentinel center with a clinical suspicion of pneumonia. Presence of influenza A and B, parainfluenza 1, 2, 3 and 4, human adeno-, boca-, corona-, metapneumo-, rhino- and respiratory syncytial virus (RSV) was determined by real-time PCR.

Results

Of 3,209 episodes of suspected pneumonia viral etiology was tested in 2,917 and proportions with influenza, human metapneumo virus and RSV were 4.6%, 2.5% and 3.1%, respectively. There were 1,653 oropharyngeal swabs for PCR testing available from 1,814 episodes that fulfilled criteria for CAP, yielding 23 first episodes of IA-CAP in the PCV13 and 35 in the in placebo group (vaccine efficacy (VE) for IA-CAP of 34.4% (95%CI -11.1% to 61.2%; p=0.117)). Annual influenza vaccination was received by 672 (87.2%) PCV13 and 719 (87.7%) placebo subjects of the confirmed CAP cases.

Conclusion

In a randomized study of 84,496 elderly with a high uptake of influenza vaccination, PCV13 was not associated with a statistically significant reduction of influenza or viral associated CAP. Overall incidence of non-influenza viral pneumonia was low.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17305438