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Pneumococcal disease is a major cause of clinical and economic burden worldwide. This study investigated the burden of pneumococcal disease in Swedish adults. A retrospective population-based study was conducted using Swedish national registers, including all adults aged ≥18 years with a diagnosis of pneumococcal disease (defined as pneumococcal pneumonia, meningitis, or septicemia) in inpatient or outpatient specialist care between 2015–2019. Incidence and 30-day case fatality rates, healthcare resource utilization, and costs were estimated. Results were stratified by age (18–64, 65–74, and ≥75 years) and the presence of medical risk factors. A total of 10,391 infections among 9,619 adults were identified. Medical factors associated with higher risk for pneumococcal disease were present in 53% of patients. These factors were associated with increased pneumococcal disease incidence in the youngest cohort. In the cohort aged 65–74 years, having a very high risk for pneumococcal disease was not associated with an increased incidence. Pneumococcal disease incidence was estimated at 12.3 (18–64), 52.1 (64–74), and 85.3 (≥75) per 100,000 population. The 30-day case fatality rate increased with age (18–64: 2.2%, 65–74: 5.4%, ≥75: 11.7%), and was highest among septicemia patients aged ≥75 (21.4%). The 30-day average number of hospitalizations was 1.13 (18–64), 1.24 (64–74) and 1.31 (≥75). The average 30-day cost/infection was estimated at €4,467 (18–64), €5,278 (65–74), and €5,898 (≥75). The 30-day total direct cost of pneumococcal disease between 2015–2019 was €54.2 million, with 95% of costs from hospitalizations. The clinical and economic burden of pneumococcal disease in adults was found to increase with age, with nearly all costs associated with pneumococcal disease from hospitalizations. The 30-day case fatality rate was highest in the oldest age group, though not negligible in the younger age groups. The findings of this study can inform the prioritization of pneumococcal disease prevention in adult and elderly populations.

Background Timely and complete vaccination with multi-dose schedules is of public health importance, because an incomplete vaccination series may yield suboptimal disease protection. However, data on adherence of adults to multi-dose vaccines are limited. We sought to estimate adherence to multi-dose hepatitis vaccination schedules among adults in the United Kingdom (UK). Methods This retrospective cohort study was conducted using anonymized electronic health record (EHR) data from the Clinical Practice Research Datalink (CPRD). Individuals aged 19 years and older at their first identified dose of hepatitis vaccine (2009–2016) were included if they had continuous EHR data for 12 months before the first identified hepatitis A dose or for 6 months before the first identified hepatitis B or combination hepatitis A/B dose. We estimated dose and series completion for each vaccine and adherence to recommended vaccination schedules, as well as adherence within additional prespecified time periods after the first vaccine dose, with sensitivity analyses restricted to adults who had available data for up to 24 months after the first dose. Median time to series completion was estimated using Kaplan-Meier methods. Results Mean (SD) age at initiation was 42 (16) years for hepatitis A ( n  = 374,881), 40 (16) years for hepatitis B ( n  = 71,634), and 38 (15) years for hepatitis A/B ( n  = 10,335). Women comprised 52 to 55% of each vaccine cohort. Overall, 42,294 adults (11%) completed the two-dose hepatitis A vaccine series within the recommended 12 months; and 15,564 (22%) and 1076 (10%) completed the three-dose hepatitis B and hepatitis A/B series, respectively, within the recommended 6 months. These percentages rose to only 23, 35, and 33%, respectively, when the follow-up periods were extended to 36 months for hepatitis A and to 30 months for hepatitis B and A/B vaccines. Median times to series completion within recommended schedules were not reached in any cohort. Sensitivity analyses supported the primary findings for the full cohorts. Conclusions Adherence and series completion rates for hepatitis A and B vaccines in the UK are low. Identifying, understanding, and addressing barriers to series completion for multi-dose vaccines for adults in real-world settings are needed.

Introduction This study aimed to estimate and compare the lifetime clinical and economic burden of invasive pneumococcal diseases (IPD) attributable to the serotypes contained in a new 21-valent pneumococcal conjugate vaccine (V116) vs. the 20-valent pneumococcal conjugate vaccine (PCV20) among adults aged 18 years and above in the USA. Methods A state-transition Markov model was used to track IPD cases and deaths as well as the associated direct medical costs (in 2023 US dollars) from a US healthcare payer perspective at 3% annual discount rate. The results were summarized for V116, PCV20, and eight unique serotypes contained in V116. A sensitivity analysis was conducted to determine the most influential inputs on the overall total direct lifetime cost. Results For the total population of US adults aged 18 years and above in 2021 (approx. 258 million residents), the estimated lifetime numbers of cases of IPD, post-meningitis sequelae (PMS), and IPD-related deaths attributable to the serotypes contained in V116 were approximately 1.4 million, 17,608, and 186,200, respectively, with a total discounted lifetime direct cost of $32.6 billion. A substantial proportion (approx. 31%) of those were attributable to the unique eight serotypes. The corresponding estimates for PCV20 were approximately 35% lower—934,000, 11,500, and 120,000, respectively—with a total discounted direct lifetime cost of $21.9 billion. Conclusion These results show that V116 serotypes (compared to PCV20) are associated with substantially higher clinical and economic burden of IPD. The addition of V116 to vaccination recommendations can help to reduce the residual burden of IPD in US adults.

Background The long-term morbidity associated with community-acquired pneumonia (CAP) and the risk factors associated with this long-term morbidity are unclear. In adults hospitalized for CAP, we sought to quantify the impact of CAP on loss of function, cognitive impairment, loss of employment, and quality of life six months after hospitalization for CAP and identify risk factors for these adverse outcomes. Design This prospective cohort study is an analysis of the Pneumococcal Pneumonia Epidemiology, Urine serotyping, and Mental Outcomes (PNEUMO) study population conducted at an academic, quaternary care hospital. Patients aged ≥ 50 years old and hospitalized for CAP between 2018 and 2020 were included in this analysis. Risk factors, including demographics, pre-illness status, comorbidities, delirium at enrollment, and pneumococcal etiology, were considered. Follow-up was conducted by phone six months after hospitalization for CAP to assess basic and instrumental activities of daily living (ADL), cognition, employment, and quality of life. Proportional odds logistic regression was performed to evaluate the association between potential risk factors and long-term morbidity. Results Of the 296 patients included in this analysis, 12.8% lost the ability to perform at least 1 basic ADL, 22.8% lost the ability to perform at least 1 instrumental ADL, 41.6% met criteria for cognitive impairment, 58.7% had a loss of employment, and 23.6% had decreased quality of life at 6-months. Poorer pre-illness ability to perform instrumental ADLs and quality of life, lower education, female sex, former and current tobacco use, past history of dementia, and delirium were associated with worsening 6-month outcomes, with the exception of employment. Conclusions Adult patients hospitalized for CAP suffered from significant morbidity at 6 months after discharge. Strategies are needed to prevent or mitigate these adverse outcomes, especially among those at higher risk.

Background Despite recommendations from the German Standing Committee on Vaccination (STIKO), pneumococcal vaccination coverage remains low in vulnerable populations. This study estimated the pneumococcal vaccination coverage rate (VCR) and timing among individuals aged 16–59 years in Germany who were recommended to receive pneumococcal vaccination, according to STIKO. Methods A retrospective cohort analysis was conducted using the German InGef database. Individuals aged 16 to 59 years diagnosed with at least one “at-risk” (chronic disease) or “high-risk” (e.g., immunocompromising) condition considered to be at-risk of pneumococcal infection were identified at the time of first diagnosis, between January 1, 2016 and December 31, 2018, and followed up until December 31, 2019. The percentage of cumulative pneumococcal VCR with 95% confidence interval (CI) was reported for each calendar year of follow-up. Results There were 334,292 individuals followed for a median of 2.38 (interquartile range (IQR) 1.63–3.13) person years. For individuals aged 16–59 years diagnosed with an incident risk condition in 2016, pneumococcal VCR increased from 0.44% (95% CI 0.41–0.48) in 2016 to 1.24% (95% CI 1.18–1.30) in 2019. In 2019, VCRs were higher in individuals with high-risk conditions compared with at-risk conditions (2.24% (95% CI 2.09–2.40) vs. 0.90% (95% CI 0.85–0.96)). In 2019, VCRs were higher in individuals aged 50 to 59 years compared with individuals aged 16 to 49 years (2.25% (95% CI 2.10–2.41) vs. 0.90% (95% CI 0.84–0.96)). Similar trends were observed in individuals with newly diagnosed risk conditions identified in 2017 and in 2018. Older age, influenza vaccination and increasing number of risk conditions increased the likelihood of pneumococcal vaccination. Median time to vaccination from diagnosis of the risk condition was shorter for high-risk conditions (369.5 days (IQR 155.8–702.0)) compared to at-risk conditions (435.5 days (IQR 196.3–758.8)). Conclusion Despite recommendations from STIKO, pneumococcal vaccination coverage remains very low and with long delays in vulnerable individuals aged 16–59 in Germany. Further efforts are required to increase immunization levels and shorten time to vaccination among individuals 16–59 years of age developing conditions with higher susceptibility to pneumococcal infection.

In Italy, a sequential pneumococcal vaccination with conjugate vaccine (PCV) and polysaccharide vaccine (PPSV23) is recommended for individuals aged ≥ 65 years and those at risk for pneumococcal disease (PD) aged ≥ 6 years. The aim of this study was to assess the cost-effectiveness of the new vaccines, i.e., approved 15-valent and 20-valent PCVs. A published Markov model was adapted to evaluate the lifetime cost-effectiveness of vaccination with PCV15 + PPSV23 versus PCV13 + PPSV23, PCV20 alone, PCV20 + PPSV23, and No Vaccination. Simulated cohorts representing the Italian population, including individuals aged ≥ 65 years, those at risk aged 50–100 years, and those deemed high risk aged 18–100 years were assessed. Outcomes were accrued in terms of incremental PD cases, costs, quality-adjusted life years, life years, and the cost–utility ratio relative to PCV13 + PPSV23. The conservative base case analysis, including vaccine efficacy based on PCV13 data, showed that sequential vaccination with PCV15 or PCV20 in combination with PPSV23 is preferred over sequential vaccination with PCV13 + PPSV23. Especially in the high-risk group, PCV15 + PPSV23 sequential vaccination was dominant over No Vaccination and resulted in an ICUR of €3605 per QALY gained. Including PCV20 + PPSV23 into the comparison resulted in the domination of the PCV15 + PPSV23 and No Vaccination strategies. Additionally, explorative analysis, including the geometric mean titer (GMT) informed vaccine effectiveness (VE) was performed. In the low-risk and high-risk groups, the results of the GMT scenarios showed PCV15 + PPSV23 to be dominant over the other sequential vaccines. These findings suggest that if real-world studies would confirm a difference in vaccine effectiveness of PCV15 and PCV20 versus PCV13 based on GMT ratios, PCV15 + PPSV23 could prove a highly immunogenic and effective vaccination regime for the Italian adult population.

Invasive pneumococcal disease (IPD) is associated with a significant clinical and economic burden among adults ≥65 years of age in Europe. The distribution of bacterial serotypes responsible for IPD has changed over time, including in response to the introduction of pediatric and adult pneumococcal conjugate vaccines (PCVs). These shifts necessitate the ongoing development of new multivalent vaccines to ensure that pneumococcal vaccination programs continue to target serotypes associated with significant disease burden. The aim of the current study was to compare the proportion of IPD cases among adults ≥65 years of age that are targetable with PCV21 compared to PCV20 in multiple European countries, and to assess trends in these proportions over time. We synthesized age- and serotype-specific IPD incidence data from 2011 to 2023. Data were obtained from government surveillance reports and peer-reviewed publications. Continuous serotype-specific data on the incidence of IPD among adults ≥65 years of age were available for 15 European countries. The average proportion of these IPD cases that were targetable by PCV21 increased during the study period; from 2014 onward, this proportion exceeded the proportion of cases targetable by PCV20, with an overall difference in serotype coverage of 14.0 % by 2023. These trends were driven largely by 8 countries that had a markedly higher reported incidence of IPD between 2011 and 2019 compared to the other 7 countries. In many European countries, PCV21-targetable serotypes are now responsible for more cases of IPD among adults ≥65 years of age than are PCV20-targetable serotypes. Implementing PCV21 in adult pneumococcal vaccination programs may therefore help reduce the clinical and economic burden of IPD among this high-risk age group. •This study synthesizes invasive pneumococcal disease data in Europe (2011−2023).•PCV21 targeted more cases in adults ≥65 than PCV20 in many European countries.•Serotype coverage of PCV21 exceeded PCV20 in 15 European countries from 2014 onward.•By 2023, PCV21 covered 14 % more cases than PCV20 among older European adults.•PCV21 vaccination may reduce the burden of invasive pneumococcal disease in Europe.

Background There are significant racial and environmental disparities in the burden of pneumococcal disease. Understanding the role of social determinants of health (SDoH) on pneumococcal disease can help health authorities identify health inequities and develop interventions to reduce these disparities. This targeted literature review (TLR) aimed to examine the clinical and economic burden of pneumococcal disease in US adults with a focus on SDoH such as race, urbanicity, and socioeconomic status. Methods A TLR of studies published between January 2012 and July 2024 was conducted using PubMed (via Medline) and Centers for Disease Control and Prevention (CDC) surveillance data. Supplementary searches were made on Google Scholar to address data gaps. Outcomes of interest were incidence, prevalence, mortality, healthcare resource use, costs, and vaccine coverage rates by race/ethnicity, urbanicity (population density), and socioeconomic variables (income, education, employment status and home ownership). Results Of 4,609 identified publications, 12 studies were included. Black adults had the highest incidence and mortality rates and longest hospital stay due to pneumococcal disease across all adult age groups. Additionally, Black (compared to non-Black) adults were more likely to be hospitalized at younger ages (50–64 years). Black adults ≥50 years incurred significantly higher pneumococcal disease hospitalization costs compared to non-Black adults. Lower urbanicity displayed higher mortality rates for adults with pneumonia. Adult patients 18–64 years living in more disadvantaged areas had a higher risk of hospitalization for IPD. Similarly, adults living in higher levels of area-based poverty had increased rates of CAP hospitalizations. Incidence of community-acquired pneumonia (CAP) was higher in early retirees and their adult dependents compared to their employed counterparts and adult dependents. Vaccination rates were lower in Black adults, rural residents, those with lower SES, education or income, blue-collar workers, and those who did not own a home. Conclusion Disparities in pneumococcal disease burden and vaccination uptake exist among US adults, particularly among Black adults, rural residents and those with lower education and income. There is paucity of studies examining disparities in pneumococcal disease and inequities according to race, urbanicity, and socioeconomic status warranting further investigation of the topic to inform prevention strategies.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends pneumococcal vaccination for adults with chronic or immunocompromising conditions to prevent pneumococcal disease, yet vaccination rates are low and have limited information on regional variation. This study examines factors associated with pneumococcal vaccination in adults with underlying conditions and describes regional variation in vaccination across the U.S. Using IBM MarketScan Commercial Database and Medicare Supplemental Database, this retrospective cohort study included adults ages 19–64 newly diagnosed with chronic (i.e. diabetes, chronic heart, lung, or liver disease, alcohol or tobacco dependence) or immunocompromising (i.e. cancer, chronic renal disease, organ transplant, HIV/AIDS, and asplenia) conditions in 2013. Adults were followed up until the time of pneumococcal vaccination, death, or December 31, 2019, whichever came first. Cox proportional hazards model was used to examine factors associated with vaccination. Vaccination rate was calculated by metropolitan statistical area (MSA) and visually represented on a U.S. map. 255,330 adults were included. Vaccination rate increased from 6.0% to 21.1% among adults with one year and five years of follow-up, respectively. It took 2.4 years on average for adults to receive vaccination after initial diagnosis. Adults ages 50–64, 35–49 (relative to 19–34) or receiving influenza vaccination were more likely to receive pneumococcal vaccinations. Adults with HIV/AIDS were more likely and those with other conditions were less likely to be vaccinated than those with diabetes. Adults being diagnosed by other providers were less likely to be vaccinated than those diagnosed by primary care providers. Vaccination rate varied largely across MSAs, ranging from 0.0% (Ames, IA; Cheyenne, WY) to 34.0% (Ann Arbor, MI). Pneumococcal vaccination remains low and most adults with underlying conditions are unvaccinated. Insights into factors associated with vaccination, including regional variability, can help to increase pneumococcal vaccination.

Background Prior research suggests that many patients do not spontaneously include work/income loss when responding to utility assessments, although this remains unconfirmed in the US due to almost no published US-based studies to date, and has not been previously studied among patients with herpes zoster (HZ). The objective of this study was to examine whether patients with HZ consider work and income loss when completing a quality of life survey. Methods A cross-sectional survey was administered to 2000 US adult commercial health plan enrollees aged 50–64 years with ≥ 1 HZ medical claim during 2014. The survey collected information related to health status (EQ-5D), work productivity, and HZ severity and clinical features. Results Mean respondent age was 58.4 years [standard deviation (SD) 4.1] and 62.0% were female. About 3 in 4 (76.8%) patients ( N  = 772) were employed either full (69.9%) or part time (6.9%). Less than half (45%) spontaneously considered work/income loss when responding to EQ-5D, and mean EQ-5D scores for patients who considered work/income loss were lower than for patients who did not [0.56 (SD = 0.28) vs. 0.69 (SD = 0.24); p  < 0.001]. Overall, 43% of patients reported at least one full day missed (mean = 9 full days) and 29% reported at least one partial day missed (mean = 6 partial days) during the most recent shingles episode. Patients who considered work loss were more likely to have missed full (76.4% vs 26.0%, p  < 0.001) or partial (70.9% vs. 35.2%, p  < 0.001) days. Patients with absenteeism were more likely to consider work/income loss when completing EQ-5D [odds ratio (OR) = 7.91, 95% confidence interval (CI) 5.01–12.31]. Odds of absenteeism/presenteeism increased significantly with increasing levels of HZ severity, and higher odds were associated with pain located on the face/scalp/neck/eye/ear (OR 1.90, 95% CI 1.06–3.40) and with pain lasting 12+ months (OR = 2.91, 95% CI 1.14–7.42). Conclusions HZ has considerable impact on the work and productivity of adults aged 50–64 years old. However, many patients with HZ do not spontaneously consider work/income loss when completing a standardized quality of life questionnaire. Studies that use health state utilities in HZ based on EQ-5D may not fully reflect the societal costs of work loss.