Pneumococcal Vaccine Lowers Hospitalization Risk for Elderly

Amanda Schmidt

December 06, 2022

Older adults who received the pneumococcal conjugate vaccine (PCV13) were less likely to be hospitalized for pneumonia, even if they had comorbidities that increased their risk for bad outcomes from the infection, according to a new study published Monday in JAMA Internal Medicine.

People who were immunized were 6.7% less likely to be hospitalized for pneumonia compared with those who were unvaccinated, according to the analysis of more than 24 million Medicare beneficiaries. 

Co-author Cynthia Whitney, MD, MPH, said she hoped the findings raise awareness around the relatively new vaccine for pneumococcal pneumonia, which sends roughly 150,000 Americans to the hospital every year

"To have a vaccine available that can prevent those serious infections is really great," Whitney, a professor at the Rollins School of Public Health at Emory University in Atlanta, Georgia, told Medscape Medical News. "We hope that people will hear about the results and be more eager to take the vaccine and providers will make sure they encourage patients to take it." 

Pneumonia consistently ranks as one of the top causes of death in the United States, according to the Centers for Disease Control and Prevention. Older adults are especially at risk; people over age 80 had a 37.7% risk for death from the disease, the highest mortality rate associated with pneumonia, 2020 data show.

The CDC's Advisory Committee on Immunization Practices in 2014 announced a new recommendation that all US adults older than 65 years receive the PCV13 vaccine. The guidelines were updated last year to recommend older adults get one or more doses of newly licensed versions of the pneumococcal conjugate vaccine. In addition, the PCV13 vaccine is currently recommended for infants and children. 

Using Medicare claims and enrollment databases, Whitney and colleagues found that fewer than 1% of enrollees in late 2014 had received a dose of the PCV13 vaccine, and about 71% had not received a pneumococcal vaccine. Nearly a third of Medicare beneficiaries at that time had received the pneumococcal polysaccharide vaccine PPSV23, an older version of the shot. 
Researchers did not examine the effectiveness of the PPSV23 vaccine against pneumonia.

By December of 2017, fewer than half of Medicare beneficiaries remained unvaccinated against the virus. About 1 in 5 had received a single dose of PCV13 roughly 20% had received shots of both PCV13 and PPSV23, according to the researchers.  

By 2017, hospitalizations had fallen for those who received the PCV13 injection. Among those who had received only PCV13, 131.4 per 100,000 people were hospitalized, averaged over each month. Hospitalization rates among the unvaccinated overall were 6.7% higher when adjusted for factors including age, race, or use of healthcare, the study concluded  (95% CI, 5.9% - 7.5%; P < .05). 

Patients who had chronic medical conditions and immunocompromising conditions had a 5.8% lower risk for pneumonia hospitalization than those who didn't receive the vaccination (95% CI, 5.0 - 6.7; P < .05). The difference after older adults received a vaccination was most pronounced among low-risk beneficiaries, with PCV13 associated with a 15.1% lower risk for hospitalizations in that group  (95% CI, 12.2 - 18.1; P < .05).

Whitney said the results make her wonder what would have happened if her own father-in-law, who died from pneumonia before the new vaccine came onto the market, would have been saved. 

"I just can't help thinking if this vaccine were available when he got ill, maybe he wouldn't have even gotten ill," Whitney said. 

In an accompanying commentary, Amber Hsiao, MPH, and Nicola P. Klein, MD, PhD, both from the Kaiser Permanente Vaccine Study Center in Oakland, California, write that they were also hopeful the new data, combined with last year's new guidelines for older adults to get a pneumococcal vaccine, raises awareness about the vaccine's benefits. Hsiao is a senior research project manager and Klein a senior research scientist with KPVSC.

Research released earlier this year by Hsiao and colleagues found a decrease in hospitalizations among those who had the PCV13 vaccine in a cohort study of more than 192,000 adults. 

With the study finding that the vaccine helped avert 35,127 hospitalizations, the immunizations can reduce stress on the overwhelmed US healthcare system and deliver significant cost-savings, Hsiao and Klein write. A typical pneumonia hospitalization costs about $11,000, they noted. 

"While costs will vary depending on individual risk, preventing pneumonia hospitalizations in older, vulnerable populations using an available, effective vaccine offers value from a clinical and public health perspective," Hsiao and Klein say. 

The study was funded by the US Centers for Disease Control and Prevention. Co-author Thomas MaCurdy, PhD, reported research funding from the US Centers for Medicare & Medicaid Services and the US Food and Drug Administration during the conduct of the study. No other authors reported relevant financial relationships. 

JAMA Intern Med. Published online December 5, 2022. Abstract

Amanda Schmidt is a journalist living in Virginia.

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