Mortality reduction with 23-valent pneumococcal polysaccharide vaccine: a systematic review and meta-analysis

Muhammed Shabil; Shilpa Gaidhane; Suhas Ballal; Sanjay Kumar; Mahakshit Bhat; Shilpa Sharma; M Ravi Kumar; Sarvesh Rustagi; Mahalaqua Nazli Khatib; Nishant Rai; Sanjit Sah; Edward Mawejje; Ganesh Bushi; Kiran Bhopte; Rachna Kathuria; Ambanna Yappalparvi

doi:10.1186/s41479-024-00149-5

Mortality reduction with 23-valent pneumococcal polysaccharide vaccine: a systematic review and meta-analysis

Pneumonia (Nathan). 2024 Dec 25;16(1):30. doi: 10.1186/s41479-024-00149-5.

Authors

Muhammed Shabil^#^{1

2}, Shilpa Gaidhane^#³, Suhas Ballal⁴, Sanjay Kumar⁵, Mahakshit Bhat⁶, Shilpa Sharma⁷, M Ravi Kumar⁸, Sarvesh Rustagi⁹, Mahalaqua Nazli Khatib¹⁰, Nishant Rai^{11

12}, Sanjit Sah^{13

14}, Edward Mawejje¹⁵, Ganesh Bushi¹⁶, Kiran Bhopte¹⁷, Rachna Kathuria¹⁸, Ambanna Yappalparvi¹⁹

Affiliations

¹ University Center for Research and Development, Chandigarh University, Mohali, Punjab, India.
² Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq.
³ One Health Centre, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India.
⁴ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India.
⁵ Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India.
⁶ Department of Medicine, National Institute of Medical Sciences, NIMS University Rajasthan, Jaipur, India.
⁷ Chandigarh Pharmacy College, Chandigarh Group of Colleges-Jhanjeri, Mohali, Punjab, 140307, India.
⁸ Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India.
⁹ School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India.
¹⁰ Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India. nazlikhatib@dmiher.edu.in.
¹¹ Department of Biotechnology, Graphic Era, Deemed to be University, Clement Town Dehradun, Dehradun, 248002, India.
¹² Department of Allied Sciences, Graphic Era Hill University Clement Town Dehradun, Dehradun, 248002, India.
¹³ Department of Paediatrics, Hospital and Research Centre, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
¹⁴ Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
¹⁵ School of Public Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda. emawejje62@gmail.com.
¹⁶ Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, India.
¹⁷ IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh, 462044, India.
¹⁸ New Delhi Institute of Management, Tughlakabad Institutional Area, New Delhi, India.
¹⁹ School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India.

^# Contributed equally.

Abstract

Background: Pneumococcal disease, caused by Streptococcus pneumoniae, imposes a significant global health burden, particularly affecting vulnerable groups such as the elderly and immunocompromised. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is designed to protect against 23 serotypes of Streptococcus pneumoniae. However, there is ongoing debate about its effectiveness in reducing all-cause mortality. This systematic review and meta-analysis aimed to evaluate the efficacy of PPV23 in reducing all-cause and pneumonia-related mortality among adults.

Methods: A systematic search was conducted across PubMed, Embase, and Web of Science, focusing on studies that evaluated the mortality outcomes of adults vaccinated with PPV23 compared to non-vaccinated adults. Both randomized controlled trials (RCTs) and observational studies were included, while case reports, case series, and non-human studies were excluded. Data extraction and quality assessment were facilitated by Nested Knowledge software, using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for RCTs.

Results: The search yielded 826 records, with 19 studies meeting the inclusion criteria. The pooled analysis of four RCTs showed no significant reduction in all-cause mortality (RR = 1.030; 95% CI: 0.945, 1.122). However, analysis of pneumonia-related mortality across various studies indicated a significant reduction (HR = 0.504; 95% CI: 0.316, 0.693). Moderate to high heterogeneity was noted in mortality studies, and a potential publication bias was identified.

Conclusion: The findings suggest that while PPV23 may not significantly reduce all-cause mortality, it is effective in reducing pneumonia-related mortality among adults, particularly in those at higher risk. These results support the continued use of PPV23 in targeted adult populations, emphasizing the need for more primary studies to explore its effectiveness across diverse groups.

Keywords: Meta-analysis; Mortality; PPV23; Pneumonia; Vaccination.

Publication types

Review