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Should older adult pneumococcal vaccination recommendations change due to decreased vaccination in children during the pandemic? A cost-effectiveness analysis.
Smith, Kenneth J; Wateska, Angela R; Nowalk, Mary Patricia; Lin, Chyongchiou J; Harrison, Lee H; Schaffner, William; Zimmerman, Richard K.
  • Smith KJ; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: smithkj2@upmc.edu.
  • Wateska AR; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: arw74@pitt.edu.
  • Nowalk MP; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: tnowalk@pitt.edu.
  • Lin CJ; Ohio State University College of Nursing, Columbus, OH, United States. Electronic address: lin.3782@osu.edu.
  • Harrison LH; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: lharriso@edc.pitt.edu.
  • Schaffner W; Vanderbilt University School of Medicine, Nashville, TN, United States. Electronic address: william.schaffner@vanderbilt.edu.
  • Zimmerman RK; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: zimmer@pitt.edu.
Vaccine ; 39(31): 4278-4282, 2021 07 13.
Article in English | MEDLINE | ID: covidwho-1275753
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumococcal Infections / COVID-19 Type of study: Experimental Studies / Observational study Topics: Vaccines Limits: Aged / Child / Child, preschool / Humans Language: English Journal: Vaccine Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumococcal Infections / COVID-19 Type of study: Experimental Studies / Observational study Topics: Vaccines Limits: Aged / Child / Child, preschool / Humans Language: English Journal: Vaccine Year: 2021 Document Type: Article