Burden of Lower Respiratory Tract Infections Preventable by Adult Immunization With 15- and 20-Valent Pneumococcal Conjugate Vaccines in the United States

Abstract

Abstract Background Updated recommendations of the US Advisory Committee on Immunization Practices indicate that all adults aged ≥65 years and adults aged <65 years with comorbid conditions should receive 15- and 20-valent pneumococcal conjugate vaccines (PCV15/20). We aimed to assess the potential impact of these recommendations on the burden of lower respiratory tract infections (LRTIs) among adults. Methods We estimated the incidence of LRTI cases and associated hospital admissions among enrollees of Kaiser Permanente Southern California from 2016 through 2019. We used a counterfactual inference framework to estimate excess LRTI-associated risk of death up to 180 days after diagnosis. We used prior estimates of PCV13 effectiveness against LRTI to model potential direct effects of PCV15/20 by age group and risk status. Results Use of PCV15 and PCV20, respectively, could prevent 89.3 (95% confidence interval, 41.3–131.8) and 108.6 (50.4–159.1) medically attended LRTI cases; 21.9 (10.1–32.0) and 26.6 (12.4–38.7) hospitalized LRTI cases; and 7.1 (3.3–10.5) and 8.7 (4.0–12.7) excess LRTI-associated deaths, each per 10 000 person-years. Among at-risk adults aged <65 years, use of PCV15 and PCV20 could prevent 85.7 (39.6–131.5) and 102.7 (47.8–156.7) medically attended LRTI cases per 10 000 person-years; 5.1 (2.4–8.6) and 6.2 (2.8–10.2) LRTI hospitalizations per 10 000 person-years, and 0.9 (0.4–1.4) and 1.1 (0.5–1.7) excess LRTI-associated deaths per 10 000 person-years. Conclusions Our findings suggest recent recommendations, including PCV15/20 within adult pneumococcal vaccine series, may substantially reduce LRTI burden.