Pneumococcal vaccine uptake and vaccine effectiveness in older adults with invasive pneumococcal disease in Germany

Background Invasive pneumococcal disease (IPD) in people ≥60 years old is on the rise in Germany. There has been a recommendation for pneumococcal vaccination in this age group since 1998. Methods We determined the vaccination status of people ≥60 years old with IPD in Germany. We assessed vaccine effectiveness (VE) of the recommended 23-valent polysaccharide vaccine (PPV23). Results The rate of pneumococcal vaccination in older adults with IPD is low, 26%, with only 16% of people receiving a pneumococcal vaccine within the past 5 years. Age- and sex-adjusted vaccine effectiveness (VE) for PPV23 was 37% (95% confidence interval 12% - 55%). For people vaccinated with PPV23 less than 2 years prior to IPD, VE was - 20% (−131% - 34%), between 2-4 years prior to IPD, VE was 56% (20% - 76%), and 47% (17% - 63%) for those vaccinated ≥5 years ago. Excluding serotype 3, overall VE for the remaining serotypes in PPV23 was 63% (49% - 74%). For people receiving PPV23 within the past 2 years, VE against all serotypes except 3 was 49% (12% - 71%); for people vaccinated between 2-4 years prior to IPD 66% (37% - 82%); for those vaccinated ≥5 years ago, 69% (50% - 81%). VE of PPV23 against serotype 3 IPD only was -110% (- 198% - -47%). Conclusions To reduce IPD in older adults in Germany, we must increase the rate of pneumococcal vaccine uptake. For 22/23 serotypes, PPV23 was effective. Serotype 3 remains a major problem.