Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine compared to 23-valent pneumococcal polysaccharide in immunocompetent adults: A systematic review and meta-analysis

Background: Despite the use of 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults there is substantial morbidity and mortality in the elderly due to pneumococcal infections. Since 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) is in use for infant immunization programs to reduce rates of pneumococcal disease, but is not routinely used in adults. Recent literature suggests PCV13 may be used in adult vaccination programs as well. Objective: To determine the immunogenicity and safety of PCV13 compared with the PPV23 in adults. Design: Systematic review and meta-analysis. Setting: Randomized controlled trials evaluating immunogenicity of a single dose of PCV13 and PPV23 in adults by the opsonophagocytic assay (OPA) geometric mean titer (GMT) response at 1-month post-vaccination were considered for inclusion. Results: Five randomized trials were included with 4561 subjects ranging 50-95.5 years, consisting of 51% females. The pooled OPA GMT ratio (GMTR) in the PCV13 arm was significantly higher for 10 of 13 serotypes (1, 4, 5, 6A, 6B, 9V, 18C, 19A, 19F and 23F) compared with the PPV23 arm. Overall, pooled risk ratios (RR) for local and systemic reactions did not differ between PCV13 and PPV23. Pneumococcal naive subjects experienced significantly higher local reactions in the PCV13 arm compared with the PPV23 arm (RR: 1.15, 95%Cl: 1.05-1.26, p = 0.0025). Conclusion: A single dose of PCV13 elicits a better immune response among adults compared with PPV23, while having a similar safety profile to PPV23. (C) 2019 Elsevier Ltd. All rights reserved.