Optimal age targeting for pneumococcal vaccination in older adults; a modelling study.
Deus Thindwa, Samuel Clifford, Jackie Kleynhans, Anne von Gottberg, Sibongile Walaza, Susan Meiring, Todd D Swarthout, Elizabeth Miller, Peter McIntyre, Nick Andrews, Zahin Amin-Chowdhury, Norman Fry, Kondwani C Jambo, Neil French, Samanta Cristine Grassi Almeida, Shamez N Ladhani, Robert S Heyderman, Cheryl Cohen, Maria Cristina de Cunto Brandileone, Stefan Flasche
Author Information
Deus Thindwa: Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK. deus.thindwa@gmail.com. ORCID
Samuel Clifford: Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Jackie Kleynhans: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. ORCID
Anne von Gottberg: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. ORCID
Sibongile Walaza: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
Susan Meiring: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. ORCID
Todd D Swarthout: Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi. ORCID
Elizabeth Miller: Department of Infectious Disease Epidemiology London School of Hygiene & Tropical Medicine, London, UK.
Peter McIntyre: University of Otago, Dunedin, New Zealand.
Nick Andrews: Immunisation and Countermeasures Division, UK Health Security Agency, London, UK.
Zahin Amin-Chowdhury: Immunisation and Countermeasures Division, UK Health Security Agency, London, UK.
Norman Fry: Immunisation and Countermeasures Division, UK Health Security Agency, London, UK. ORCID
Kondwani C Jambo: Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi. ORCID
Neil French: Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi.
Samanta Cristine Grassi Almeida: National Laboratory for Meningitis and Pneumococcal Infections, Laboratory for Meningitis, Pneumonia and Pneumococcal Infection, Centre of Bacteriology, S��o Paulo, Brazil.
Shamez N Ladhani: Immunisation and Countermeasures Division, UK Health Security Agency, London, UK.
Robert S Heyderman: Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi. ORCID
Cheryl Cohen: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. ORCID
Maria Cristina de Cunto Brandileone: National Laboratory for Meningitis and Pneumococcal Infections, Laboratory for Meningitis, Pneumonia and Pneumococcal Infection, Centre of Bacteriology, S��o Paulo, Brazil.
Stefan Flasche: Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK. ORCID
Invasive pneumococcal disease (IPD) risk increases with age for older adults whereas the population size benefiting from pneumococcal vaccines and robustness of immunogenic response to vaccination decline. We estimate how demographics, vaccine efficacy/effectiveness (VE), and waning VE impact on optimal age for a single-dose pneumococcal vaccination. Age- and vaccine-serotype-specific IPD cases from routine surveillance of adults ������55 years old (y), ������4-years after infant-pneumococcal vaccine introduction and before 2020, and VE data from prior studies were used to estimate IPD incidence and waning VE which were then combined in a cohort model of vaccine impact. In Brazil, Malawi, South Africa and England 51, 51, 54 and 39% of adults older than 55���y were younger than 65���years old, with a smaller share of annual IPD cases reported among <���65���years old in England (4,657; 20%) than Brazil (186; 45%), Malawi (4; 63%), or South Africa (134, 48%). Vaccination at 55���years in Brazil, Malawi, and South Africa, and at 70���years in England had the greatest potential for IPD prevention. Here, we show that in low/middle-income countries, pneumococcal vaccines may prevent a substantial proportion of residual IPD burden if administered earlier in adulthood than is typical in high-income countries.
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