Pneumococcal vaccination and primary care presentations for acute respiratory tract infection and antibiotic prescribing in older adults

Fariha Binte Hossain; Sanjay Jayasinghe; Katrina Blazek; Wen-Qiang He; Bette Liu

doi:10.1371/journal.pone.0299924

Pneumococcal vaccination and primary care presentations for acute respiratory tract infection and antibiotic prescribing in older adults

PLoS One. 2024 Apr 18;19(4):e0299924. doi: 10.1371/journal.pone.0299924. eCollection 2024.

Authors

Fariha Binte Hossain¹, Sanjay Jayasinghe^{2

3}, Katrina Blazek¹, Wen-Qiang He³, Bette Liu^{1

2}

Affiliations

¹ School of Population Health, UNSW, Sydney, Australia.
² National Centre for Immunisation Research and Surveillance (NCIRS), Kids Research, Sydney Children's Hospitals Network, New South Wales, Sydney, Australia.
³ Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia.

Abstract

Background: While the 23-valent pneumococcal polysaccharide vaccine (PPV23) has demonstrated its role in preventing severe pneumococcal disease, its impact on more non-specific conditions like acute respiratory tract infection (ARI) and lower respiratory tract infections (LRTI) remains unclear. We aimed to investigate the role of PPV23 in prevention of presentations for ARI and LRTI and related antibiotic prescriptions among older adults in primary care.

Methods: Using a nationwide general practice dataset, we followed a cohort of regularly attending patients aged ≥65 years from 1 January 2014 until 31 December 2018 for presentations for ARI, LRTI, and related antibiotic prescriptions. Associations between PPV23 receipt and each outcome were assessed using a multiple failures survival model to estimate hazard ratios (HR) adjusted for age, sex, socioeconomic status, and various health measures.

Results: A cohort of 75,264 patients aged ≥65 years (mean 75.4, 56% female) in 2014 was followed. The incidence of presentations for ARI, ARI-related antibiotic prescription, LRTI, and LRTI-related antibiotic prescription was 157.6, 76.0, 49.6, and 24.3 per 1000 person-years, respectively. Recent PPV23 vaccine receipt was associated with a small reduction in ARI presentations (adjusted HR vaccinated vs. unvaccinated 0.96; 95%CI 0.94-0.98; p = 0.002); however, there was no reduction in ARI-related antibiotic prescription, LRTI presentation, nor LRTI-related antibiotic prescription (adjusted HR were 0.99[95%CI 0.96-1.03], 1.04[95%CI 0.99-1.09], 1.07[95%CI 1.00-1.14]).

Conclusion: PPV23 vaccination in older adults may result in a small reduction in the incidence of total ARI presentations in primary care. However, the effect is small and residual confounding cannot be excluded.

Copyright: © 2024 Hossain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Aged
Anti-Bacterial Agents / therapeutic use
Female
Humans
Male
Pneumococcal Infections* / drug therapy
Pneumococcal Infections* / prevention & control
Pneumococcal Vaccines / therapeutic use
Primary Health Care
Respiratory Tract Infections* / drug therapy
Respiratory Tract Infections* / prevention & control
Streptococcus pneumoniae
Vaccination

Substances

Anti-Bacterial Agents
Pneumococcal Vaccines

Grants and funding

Fariha Binte Hossain was supported by the Australian Government Research Training Program Scholarship. She received a University Postgraduate Award (UPA). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.