3 years ago

Impact of pneumococcal polysaccharide vaccine on incidence and mortality after pneumonia in adults aged ≥ 60 years – a population-based retrospective cohort study

The 23-valent pneumococcal polysaccharide vaccine (PPV) is recommended for prevention of pneumococcal diseases in adults at risk. Few data exist on time- age- and sex-dependent vaccine effectiveness on outcomes in pneumonia. Methods We performed a population based cohort study including adults ≥ 60 years of age (n=738.927) based on statutory health insurance data 2005-2011. Primary outcomes were all-cause pneumonia incidence and 30-day all-cause mortality. Pneumonia was identified via ICD-10 codes, ambulatory cases validated by antibiotic prescription within 7 days. The effect of PPV within 5 years was analysed after propensity score based matching (three controls per case with PPV vaccination) including comorbidities, care status, age, sex, and influenza vaccination. Evaluations were stratified by age group, sex and time of PPV. Results Two-year incidence of all-cause pneumonia in 213.431 vaccinated individuals was 7501/213.431 (3.51%) versus 23.243/640.293 (3.63%) in matched controls (difference -0.11, 95%CI -0.22—0.002, p=0.046). After sex-dependent analysis, PPV effectiveness on pneumonia incidence was observed only in females (difference -0.15, 95% CI -0.28 - -0.02, p=0.02). 30-day mortality in vaccinated individuals with pneumonia was 1302/7501 (17.36%) versus 4267/22.503 (18.96%) in matched controls (difference -1.60%, 95%CI -2.83—0.38, p=0.011). After analysis according to age group, significant mortality reduction was present only in adults of 60 to 79 years (difference -2.31, 95% CI -3.79 - -0.83, p=0.002). Year of PPV vaccination showed no effect on outcomes. Conclusions The findings support consideration of sex- and age-dependence of PPV effectiveness within further studies.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304561

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