1436. Risk Factors for Invasive Pneumococcal Disease in Adults ≥65 Years Old Following Pneumococcal Conjugate Vaccine Recommendation
Session: Poster Abstract Session: Pneumococcal Vaccines
Friday, October 5, 2018
Room: S Poster Hall
  • IDWEEK_Almendares_adultVE_RiskFactors_FINAL.pdf (271.0 kB)
  • Background: In 2014, pneumococcal conjugate (PCV13) and polysaccharide (PPSV23) vaccines were recommended in series for all U.S. adults ≥65 years. We conducted a case-control study to evaluate risk factors for invasive pneumococcal disease (IPD) among adults ≥65 years old.

    Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified through Active Bacterial Core surveillance during 2015-2018. Isolates were serotyped using whole genome sequencing. Four controls, identified through a commercial database, were matched per case by age and zip code. We obtained vaccination and medical histories from providers, vaccine registries and participant interviews. A functional status score was calculated based on participant interview. We calculated IPD odds ratios using multivariable conditional logistic regression.

    Results: We enrolled 328 IPD cases and 1,280 matched controls. Fifty percent of case-patients and 55% of controls received a dose of PCV13. Case-patients were more likely than controls to have a chronic condition (heart, liver, or lung disease, diabetes, cochlear implant, alcohol abuse, smoking; 82% vs. 59%), immunosuppression (60% vs. 32%), poor functional status (score of ≥ 3; 71% vs. 50%), annual household income <$30,000 (38% vs. 25%) and education level of high school or less (36% vs. 25%). In a multivariable model, case-patients were more likely than controls to have a chronic condition (OR 2.48, 95%CI 1.72, 3.58), immunosuppression (OR 2.56, 95%CI 1.92,3.42), poor functional status (OR 3.66, 95%CI 2.42, 5.54), and primary or secondary smoking exposure (OR 3.09, 95%CI 1.32, 7.2). In analysis limited to PCV13-type cases and matched controls, adjusting for PCV13 receipt, measures of association were no longer significant for chronic conditions (OR 1.45, 95% 0.71, 2.95), immunosuppression (OR 1.51, 95%CI 0.83, 2.74), or poor functional status (OR 1.98, 95%CI 0.91, 4.3).

    Conclusion: Chronic and immunosuppressive conditions remain IPD risk factors for adults in the era of PCV13 use; poor functional status was also identified as a risk factor. Targeted evaluation of adults with poor functional status could inform IPD prevention strategies. PCV13 may reduce the risk of PCV13-type IPD associated with chronic conditions and poor functional status.

    Olivia M. Almendares, MSPH1, Wei Xing, MS1, Monica M. Farley, MD, FIDSA2, William Schaffner, MD, FIDSA, FSHEA3, Ann Thomas, MD, MPH4, Arthur Reingold, MD, FIDSA5, Lee H. Harrison, MD6, Corinne Holtzman, MPH7, Jemma V. Rowlands, MPH8, Susan Petit, MPH9, Meghan Barnes, MSPH10, Salina Torres, PhD11, Bernard Beall, PhD1, Cynthia Whitney, MD, MPH, FIDSA1 and Tamara Pilishvili, MPH, PhD12, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (3)Vanderbilt University School of Medicine, Nashville, TN, (4)Oregon Public Health Division, Portland, OR, (5)University of California - Berkeley, Berkeley, CA, (6)Johns Hopkins University Bloomberg School of Public Health, Pittsburgh, PA, (7)Minnesota Department of Health, St. Paul, MN, (8)New York State Department of Health, Albany, NY, (9)Connecticut Department of Public Health, Hartford, CT, (10)Colorado Department of Public Health and Environment, Denver, CO, (11)New Mexico Emerging Infections Program, Santa Fe, NM, (12)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA


    O. M. Almendares, None

    W. Xing, None

    M. M. Farley, None

    W. Schaffner, Merck: Member, Data Safety Monitoring Board , Consulting fee . Pfizer: Member, Data Safety Monitoring Board , Consulting fee . Dynavax: Consultant , Consulting fee . Seqirus: Consultant , Consulting fee . SutroVax: Consultant , Consulting fee . Shionogi: Consultant , Consulting fee .

    A. Thomas, None

    A. Reingold, None

    L. H. Harrison, None

    C. Holtzman, None

    J. V. Rowlands, None

    S. Petit, None

    M. Barnes, None

    S. Torres, None

    B. Beall, None

    C. Whitney, None

    T. Pilishvili, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.