Streptococcus pneumoniae causes invasive pneumococcal disease and pneumonia. This study models the burden of adult pneumococcal disease in France. Over a 5-year period, approximately 630,000 cases and €3.1 billion of costs were attributable to pneumococcus, mostly non-invasive disease, with nearly 80% due to serotypes included in 20-valent pneumococcal conjugate vaccine.

Following the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) for children in the United States (US) in 2010, rates of invasive pneumococcal disease (IPD) among both children and adults declined substantially. The present study examined temporal trends in rates of hospitalized pneumonia (PNE) among adults by age as well as by race and socioeconomic status within age-specific subgroups. We used the Optum Clinformatics Datamart to calculate incidence (per 100K patient-years [PY]) of hospitalized all-cause PNE (AC-PNE) among adults aged ≥ 18 years during the 2008-2009 (pre-PCV13) and 2017-2019 (post-PCV13) periods, respectively. Rates were estimated within age groups (18-49, 50-64, 65-74, ≥ 75y) as well as by race (White, Hispanic, Asian, Black) and household income (< $50,000, $50,000-$99,999, ≥ $100,000). Incidence rate ratios (IRRs) comparing AC-PNE during the post-PCV13 period by race and household income were also calculated. AC-PNE hospitalization rates (per 100K PY) decreased from the pre-PCV13 period to the post-PCV13 period across all ages: 18-49y, 73 to 38 (48% reduction); 50-64y, 250 to 225 (10%); 65-74y, 616 to 490 (20%); ≥ 75y, 1,622 to 1,326 (18%) (Table 1). Similar reductions were observed within age groups across racial and income-based strata. Rates of hospitalized AC-PNE during the post-PCV13 period were higher (generally) for Blacks (IRR [range]: 1.0-1.9), and lower for Asians (IRR [range]: 0.4-0.5) and Hispanics (IRR: 0.8), relative to Whites (Table 2). Hospitalized AC-PNE rates during the post-PCV13 period were higher among adults with annual household income < $50,000 (IRR [range]: 1.3-5.1) and $50,000-$99,999 (IRR [range]: 1.1-2.2), versus those with household income ≥ $100,000. Rates of hospitalized AC-PNE among adults decreased during the decade following the introduction of PCV13 in the US, however disparities in disease rates defined by race and socioeconomic status persist. Ahuva Averin, MPP, Pfizer Inc: Grant/Research Support Mark Rozenbaum, PhD, M.B.A., Pfizer: Stocks/Bonds (Public Company) Derek Weycker, Ph.D., Pfizer Inc.: Grant/Research Support Rotem Lapidot, MD, MSCI, Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria Amanda C. Miles, MPH, Pfizer: Employee of Pfizer Inc.|Pfizer: Stocks/Bonds (Public Company) Maria J. Tort, PhD, Pfizer, Inc: Stocks/Bonds (Public Company) Jeffrey T. Vietri, PhD, Pfizer Inc: Employment|Pfizer Inc: Stocks/Bonds (Public Company) Alexander Lonshteyn, PhD, Pfizer: Grant/Research Support Stephen I. Pelton, MD, CSL Seqirus: Advisor/Consultant|GSK: Grant/Research Support|GSK: Honoraria|Merck Vaccines: Grant/Research Support|Merck Vaccines: Honoraria|Pfizer, Inc.: Grant/Research Support|Pfizer, Inc.: Honoraria|Sanofi: Honoraria|Sanofi: DSMB, Adjudicator for RSV vaccine trial

In the United States (US), children with unmet social and financial resources may face challenges completing well-child visits and immunizations. Pneumococcal conjugate vaccines (PCVs) are recommended as a 4-dose series at 2, 4, 6, and 12-15 months. The objective of this study was to characterize PCV uptake and series completion according to social determinants of health (SDOH) among children with commercial insurance. Commercially insured children with continuous enrollment from 0-24 months of age were divided into four period cohorts: (Cohort 1) 2017-2019, (Cohort 2) 2020-2022, (Cohort 3) 2021-2023, and (Cohort 4) 2023-2024. PCV doses and individual-level characteristics were identified using healthcare claims from Optum’s Clinformatics DataMart®. Children were linked to community-level SDOH characteristics from the US Census Bureau’s American Community Survey and Department of Agriculture’s Urban Influence Codes using 5-digit ZIP codes. Cumulative probabilities of 3-dose primary and full series completion were evaluated using Kaplan-Meier analyses for each cohort overall and by SDOH characteristics. Between 31,021 and 45,621 children were included in each cohort. In each cohort, around half of children were male, 13% to 15% had a risk condition or premature birth. Additionally, most were from the Midwest or South regions of the US, had a low area deprivation index (ADI), a high Theil’s index, and an urban residence (Table 1). Primary series completion by 12 months and full series completion by 24 months of age was highest in Cohort 2 and lowest in Cohort 4. Compared to earlier cohorts, series completion at 12 months decreased among children in Cohorts 3 and 4 for both ADI and Theil’s index. In general, series completion was lowest in the highest ADI tertile and in the lowest Theil’s tertile. Children in rural settings had lower series completion than children in urban settings (Tables 2-3). PCV uptake was lowest among Cohort 4, potentially reflecting declines in uptake after the COVID-19 pandemic. Uptake was also lower among children residing in rural communities or in areas with greater deprivation. Differences in PCV uptake could contribute to disparities in disease incidence among children and could be addressed with targeted vaccination programs. Amanda C. Miles, MPH, Pfizer: Employee of Pfizer Inc.|Pfizer: Stocks/Bonds (Public Company) Christopher G. Prener, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Huihua Li, MS, MD, Pfizer Pharmaceutical: employee|Pfizer Pharmaceutical: Stocks/Bonds (Public Company) Alison E. Randall, MPH, PMP, Pfizer: Employment|Pfizer: Stocks/Bonds (Public Company) Benjamin Althouse, PhD, Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds (Public Company) Mark Rozenbaum, PhD, M.B.A., Pfizer: Stocks/Bonds (Public Company) Lindsay Grant, PhD, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds (Private Company) Ronika Alexander, M.Ed, Pfizer, Inc.: employee|Pfizer, Inc.: Stocks/Bonds (Private Company) Paul Palmer, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds (Public Company) Maria J. Tort, PhD, Pfizer, Inc: Stocks/Bonds (Public Company)

BACKGROUND:Despite the significant impact of longstanding pediatric pneumococcal conjugate vaccine (PCV) use in the United Kingdom (UK), pneumococcal disease burden remains substantial. Higher valent vaccines, such as the 20‑valent PCV (PCV20), could reduce this burden, yet their value in the contemporary UK setting has not been fully assessed using recent data. RESEARCH DESIGN AND METHODS:An age-structured dynamic transmission model used post-COVID-19 UK epidemiology (2001-2023) to compare pediatric PCV20 (2 + 1 and 1 + 1) with PCV13 (1 + 1) and PCV15 (1 + 1). Over 10 years, we assessed cost-effectiveness and number needed to vaccinate (NNV), capturing disease cases, deaths, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Sensitivity and scenario analyses examined key uncertainties. RESULTS:Over 10 years, both PCV20 schedules were dominant versus PCV13 and PCV15. Versus PCV13, PCV20 1 + 1 and 2 + 1 were projected to avert 448,432 and 499,151 disease cases and save £1.509 and £1.306 billion, respectively. Versus PCV15, PCV20 1 + 1 and 2 + 1 were projected to avert 409,459 and 460,179 disease cases and save £1.424 and £1.221 billion, respectively. NNVs versus PCV13 were lower for PCV20 than PCV15 across both dosing schedules. Sensitivity and scenario results were consistent with the base case. CONCLUSION:Pediatric PCV20 implementation in the UK could deliver substantial health gains while improving economic efficiency.

Invasive pneumococcal disease (IPD) and community-acquired pneumonia pose significant health risks, particularly for older adults and those with underlying conditions. In many countries including the United States (US), vaccine policy and reimbursement decisions are informed by cost-effectiveness analysis (CEA). However, CEA is sensitive to key inputs—such as vaccine effectiveness (VE)—uncertain at time of initial review but more certain after widespread use of the vaccine. This study incorporates recently presented real-world VE of 20-valent pneumococcal conjugate vaccine (PCV20) into an established cost-effectiveness model. A published cost-effectiveness model was adapted to current US epidemiology and estimated lifetime impact of adult PCV20 use on IPD from any serotype, all-cause pneumonia, deaths, quality-adjusted life-years (QALYs), and costs on single-year cohorts of vaccine-naïve US adults using 1) VE inputs used by the Centers for Disease Control and Prevention (CDC) and 2) VE calculated from real-world data on PCV20 effectiveness against IPD and all-cause pneumonia in Medicare beneficiaries aged ≥65 years. Other model inputs (e.g., disease incidence, serotype distribution, associated costs) were taken from recent presentations of the CDC/Tulane pneumococcal cost-effectiveness model to reflect typical evaluation of adult pneumococcal vaccines. Relative to use of CDC VE assumptions, use of real-world VE inputs predicted 234 more IPD cases but 6,960 fewer inpatient pneumonia cases, 31,313 fewer outpatient cases and 166 fewer deaths, yielding 1,995 more QALYs and offsetting $332M more in medical costs over the lifetime of a cohort of 50 year old adults. The difference between the two methods was larger in a single cohort of adults aged 65 years at vaccination, with 134 more IPD cases but 35,358 fewer inpatient pneumonia cases, 78,940 fewer outpatient cases, and 1,258 fewer deaths, yielding 8,492 QALYs and offsetting $736M more in medical costs over the remaining lifetime of the cohort. Use of real-world VE reflected much greater public health and economic benefits of adult PCV20 use than using VE previously assumed. Policymakers should consider emerging real-world PCV20 VE data when considering adult pneumococcal recommendations. Jeffrey T. Vietri, PhD, Pfizer Inc: Employment|Pfizer Inc: Stocks/Bonds (Public Company) Euan Dawson, MSc, Pfizer Inc: Employment Michael Bois, PhD, M(ASCP), PFIZER: Stocks/Bonds (Public Company) Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds (Public Company) Jelena Vojicic, MD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company)|Pfizer Inc.: Stocks/Bonds (Public Company) Mark Rozenbaum, PhD, M.B.A., Pfizer: Stocks/Bonds (Public Company)

BACKGROUND:Evidence suggests that early-life community-acquired pneumonia (CAP) among healthy children increases their risk of subsequent chronic respiratory disorders. This study extends prior research by including children with and without comorbidities and conducting analyses using two databases. METHODS:Data were obtained from the Optum Electronic Health Record Database (commercial subset) and Merative Medicaid Multi-State Database. Study populations comprised children hospitalized for CAP before age 2 years ("CAP patients") as well as matched "comparison patients." Rates of study outcomes-including chronic respiratory disease (CRD), reactive airway disease (RAD), CAP hospitalization-from age 2-5 years were calculated for CAP/comparison patients in each study population, overall and by comorbidity profile. FINDINGS:Rates of study outcomes from age 2-5 years were markedly higher among CAP (vs. comparison) patients in commercial-insured and Medicaid-insured populations, by: 1·9 and 1·5 for CRD; 2·5 and 2·0 for RAD; 6·4 and 7·3 for CAP hospitalization. CAP patients with (vs. without) comorbidities had numerically higher rates of outcomes, but relative rates of outcomes for CAP (vs. comparison) patients were largely comparable irrespective of comorbidity profile. INTERPRETATION:CAP before age 2 years is associated with increased rates of CRD from age 2-5 years and the proportion of children with subsequent CRD is highest among those with comorbidities. These observations suggest a potential causative role for early-life CAP in subsequent CRD.

A 20-valent pneumococcal conjugate vaccine (PCV20) was recently recommended for use among US children. We evaluated the cost-effectiveness of PCV20 among children aged 6 years with chronic medical conditions (CMC+) and children aged 6 years with immunocompromising conditions (IC) versus one and two doses of 23-valent pneumococcal polysaccharide vaccine (PPSV23), respectively. A probabilistic model was employed to depict 10-year risk of clinical outcomes and economic costs of pneumococcal disease, reduction in life years from premature death, and expected impact of vaccination among one cohort of children with CMC+ and IC aged 6 years. Vaccine uptake was assumed to be 20

(1) Background/Objectives: Two pneumococcal conjugate vaccines, 15-(PCV15) and 20-(PCV20) valent formulations, are routinely recommended for US children in a 3+1 schedule. The first three doses are administered during the first year of life at 2, 4, and 6 months, while a booster dose is given at 12 to 15 months. This study evaluated the health and economic effects of the PCV20 infant series within the first year of life compared to PCV15. (2) Methods: Using a decision-analytic model, we calculated the health and economic effects of introducing PCV15 or PCV20 for five subsequent birth cohorts. Epidemiological data were drawn from peer-reviewed studies and estimates for vaccine effectiveness were extrapolated from established PCV13 effectiveness and PCV7 efficacy studies. Direct medical costs related to the disease treatment were extracted from the literature and inflated to 2024 dollars. (3) Results: Over the course of five years, the implementation of PCV20 vaccination for newborns in the United States, compared to PCV15, is projected to prevent an additional 220 cases of invasive pneumococcal disease, 6542 cases of community-acquired pneumonia, and 112,095 cases of otitis media within the first year of life across five subsequent birth cohorts. This strategy could prevent 66 infant deaths linked to these illnesses and confer extra health gains, amounting to 5058 years of life and 5037 quality-adjusted life years. These prevented cases are estimated to save approximately USD 147 million over 5 years. (4) Conclusions: This study demonstrated that vaccinating with PCV20 during the first 12 months of life compared to PCV15 in the US would yield a substantially greater health and economic return due to the five additional serotypes covered by PCV20.

Background: As of June 2023, two pneumococcal conjugate vaccines, 20- (PCV20) and 15- (PCV15) valent formulations, are recommended for US infants under a 3 + 1 schedule. This study evaluated the health and economic impact of vaccinating US infants with a new expanded valency PCV20 formulation. Methods: A population -based, multi cohort, decision -analytic Markov model was developed to estimate the public health impact and cost-effectiveness of PCV20 from both societal and healthcare system perspectives over 10 years. Epidemiological data were based on published studies and unpublished Active Bacterial Core Surveillance System (ABCs) data. Vaccine effectiveness was based on PCV13 effectiveness and PCV7 efficacy studies. Indirect impact was based on observational studies. Costs and disutilities were based on published data. PCV20 was compared to both PCV13 and PCV15 in separate scenarios. Results: Replacing PCV13 with PCV20 in infants has the potential to avert over 55,000 invasive pneumococcal disease (IPD) cases, 2.5 million pneumonia cases, 5.4 million otitis media (OM) cases, and 19,000 deaths across all ages over a 10 -year time horizon, corresponding to net gains of 515,000 life years and 271,000 QALYs. Acquisition costs of PCV20 were offset by monetary savings from averted cases resulting in net savings of $20.6 billion. The same trend was observed when comparing PCV20 versus PCV15, with a net gain of 146,000 QALYs and $9.9 billion in net savings. A large proportion of the avoided costs and cases were attributable to indirect effects in unvaccinated adults and elderly. From a health-care perspective, PCV20 was also the dominant strategy compared to both PCV13 and PCV15. Conclusions: Infant vaccination with PCV20 is estimated to further reduce pneumococcal disease and associated healthcare system and societal costs compared to both PCV13 and PCV15.

AimThe US Food and Drug Administration approved the 20-valent pneumococcal conjugate vaccine (PCV20) to prevent pneumococcal disease. In the context of routine PCV20 vaccination, we evaluated the cost-effectiveness and public health and economic impact of a PCV20 catch-up program and estimated the number of antibiotic prescriptions and antibiotic-resistant infections averted.Materials and methodsA population-based, multi-cohort, decision-analytic Markov model was developed using parameters consistent with previous PCV20 cost-effectiveness analyses. In the intervention arm, children aged 14-59 months who previously completed PCV13 vaccination received a supplemental dose of PCV20. In the comparator arm, no catch-up PCV20 dose was given. The direct and indirect benefits of vaccination were captured over a 10-year time horizon.ResultsA PCV20 catch-up program would prevent 5,469 invasive pneumococcal disease cases, 50,286 hospitalized pneumonia cases, 218,240 outpatient pneumonia cases, 582,302 otitis media cases, and 1,800 deaths, representing a net gain of 30,014 life years and 55,583 quality-adjusted life years. Furthermore, 720,938 antibiotic prescriptions and 256,889 antibiotic-resistant infections would be averted. A catch-up program would result in cost savings of $800 million. These results were robust to sensitivity and scenario analyses.ConclusionsA PCV20 catch-up program could prevent pneumococcal infections, antibiotic prescriptions, and antimicrobial-resistant infections and would be cost-saving in the US.

Respiratory syncytial virus (RSV) can cause severe respiratory infections in adults; however, information on associated sequelae is limited. This systematic literature review aimed to identify sequelae in adults within 1 year following RSV-related hospitalization or resolution of acute infection. Studies were identified from Embase, MEDLINE, LILACS, SciELO, and grey literature. Random-effects meta-analyses using restricted maximum likelihood were used to calculate the proportions and relative risks of sequelae in patients with RSV compared with controls (patients with RSV-negative influenza-like illness, influenza, and parainfluenza) per follow-up period, population, and treatment setting, where possible. Twenty-one relevant studies covering the period from 1990 to 2019 were included. Among the general population, the most frequent clinical sequela was sustained function loss (33.5

Most European infant national immunization programs (NIPs) recommend pneumococcal conjugate vaccines (PCVs), which currently cover 10–15 serotypes administered in a three-dose schedule (two primary plus one booster). Recently, a PCV covering 20 serotypes that is administered in a four-dose schedule (three primary plus one booster) was licensed. An online survey was administered to collect data from health care providers (HCPs) and caregivers of children aged 0–5 (including expectant mothers) in four European countries (Germany, France, Spain, and Greece). All caregiver respondents had a shared or full responsibility to make health decisions for their child. Data on opinions, perceptions, and openness to a change in childhood vaccination dosing schedules were collected, along with demographic information for HCPs as well as caregivers. A total of 601 HCPs and 1954 caregivers were recruited across the four countries. Nearly all HCPs (93

While it is widely recognized that older adults, adults with chronic medical conditions (CMC), and adults with immunocompromising conditions (IC) are at increased risk of lower respiratory tract illness (LRTI), evidence of the magnitude of increased risk is limited. This study was thus undertaken to characterize rates of hospitalized and ambulatory LRTI among United States (US) adults by age and comorbidity profile. A retrospective cohort design and US healthcare claims database (2016–2019) were employed. Study population included adults aged ≥ 18 years and was stratified by age and comorbidity profile (CMC−, CMC+ , IC). LRTI was ascertained overall and by pathogen pathogen (e.g., respiratory syncytial virus [RSV]), and was classified by care setting (hospital, emergency department [ED], physician office/hospital outpatient [PO/HO]). Relative rates (RR) of LRTI generally increased with older age across care settings (vs. 18–49 years), with the most marked increase for hospitalizations: for LRTI-hospitalized, RRs ranged from 3.3 for 50–64 years to 46.6 for ≥ 85 years; for LRTI-ED and LRTI-PO/HO, RRs ranged from 1.0 to 2.7 and from 1.3 to 1.5, respectively. Within age groups, LRTI rates were also consistently higher among CMC+ and IC adults (vs. CMC− adults). Age-specific RRs of LRTI patients hospitalized due to RSV were largely comparable to overall LRTI; age-specific RRs for other care settings, and RRs for CMC+ and IC adults (vs. CMC− adults), were generally higher for LRTI due to RSV. Incidence of LRTI, including that due to RSV, especially for events requiring acute inpatient care, is markedly higher among older adults and adults of all ages with CMC or IC.