Should older adult pneumococcal vaccination recommendations change due to decreased vaccination in children during the pandemic? A cost-effectiveness analysis. Issue 31 (13th July 2021)

• Record Type: Journal Article
• Authors: Smith, Kenneth J.; Wateska, Angela R.; Nowalk, Mary Patricia; Lin, Chyongchiou J.; Harrison, Lee H.; Schaffner, William; Zimmerman, Richard K.
• Is Part Of: Vaccine. Volume 39:Issue 31(2021)
• Page Start: 4278
• Page End: 4282
• Publication Date: 2021-07-13
• Subjects: Pneumococcal vaccination -- Elderly -- Cost-effectiveness analysis -- COVID-19; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2021.06.037
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Childhood vaccination has decreased during the pandemic, potentially leading to increased pneumococcal disease. As a result, changes to older adult pneumococcal vaccination recommendations could be considered. Plausible pneumococcal illness increases do not favor heightened PCV13 use in older adults. Current vaccination recommendations for older adults should not change based on pediatric vaccination rates. Abstract: Background: The COVID-19 pandemic is causing declines in childhood immunization rates. We examined potential COVID-19-related changes in pediatric 13-valent pneumococcal conjugate vaccine (PCV13) use, subsequent impact on childhood and adult pneumococcal disease rates, and how those changes might affect the favorability of PCV13 use in non-immunocompromised adults aged ≥65 years. Methods: A Markov model estimated pediatric disease resulting from decreased PCV13 use in children aged <5 years; absolute decreases from 10 to 50% for 1–2 years duration were examined, assuming no catch-up vaccination and that decreased vaccination led to proportionate increases in PCV13 serotype pneumococcal disease in children and seniors. Integrating pediatric model output into a second Markov model examining 65-year-olds, we estimated the cost effectiveness of older adult pneumococcal vaccination strategies while accounting for potential epidemiologic changes from decreased pediatric vaccination. Results: One year of 10–50% absolute decreases in PCV13 use in <5-year-olds increased pneumococcal disease by an estimated 4–19% in seniors; 2 years of decreased use increased senior rates by 8–38%. In seniors, a >53% increase in pneumococcal disease was required to favor PCV13 use in non-immunocompromised seniors at a $200, 000 per quality-adjusted life-year gained threshold, which corresponded to absolute decreases in pediatric PCV13 vaccination of >50% over a 2-year period. In sensitivity analyses, senior PCV13 vaccination was unfavorable if absolute decreases in pediatric PCV13 receipt were within plausible ranges, despite model assumptions favoring PCV13 use in seniors. Conclusion: COVID-19-related decreases in pediatric PCV13 use would need to be both substantial and prolonged to make heightened PCV13 use in non-immunocompromised seniors economically favorable.