Reducing the burden of Pneumococcal disease in UK adults

Campling, James Alexander (2024) Reducing the burden of Pneumococcal disease in UK adults. Doctoral thesis, University of East Anglia.

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Abstract

Background: Streptococcus pneumoniae is an encapsulated bacterium responsible for pneumococcal disease, with over 100 serotypes identified. Pneumococcal disease is a leading cause of morbidity and mortality in the UK and is categorised as non-invasive (sinusitis, otitis media and non-bacteraemic pneumonia) and invasive (bacteraemia and meningitis). Adults aged >65 years, or with certain underlying comorbidities, are at increased risk of pneumococcal disease. Pneumococcal conjugate vaccines (PCV13 and PCV20) have been successively licensed to help protect adults against pneumococcal disease caused by serotypes in each respective vaccine. The Joint Committee on Vaccination and Immunisation (JCVI) are responsible for advising the UK Government on immunisation programmes, reviewed PCV13 in 2015 but did not recommend its use in adults, based on cost-effectiveness.

Aim: A large epidemiological plan was devised to address data gaps and to establish a scientific consensus for parameters used in future health economic modelling.

Method: Work was initiated to critically assess modelling and identify shortcomings in the evidence. Key parameters identified with incomplete evidence were: 1) incidence of hospitalised community-acquired pneumonia (hCAP), 2) hCAP costs and 3) risk quantification for comorbid adults. Studies were designed and executed generating evidence for these key parameters.

Outcome: Peer-reviewed manuscripts were published describing evidence gaps, and evidence generated. This included estimates (pre- and intra-COVID-19 pandemic) of all-cause hCAP incidence of >450/100,000 in UK adults compared with a previous estimate of 80/100,000. Contemporary hCAP costs were estimated to be £3,904 vs. a prior estimate of £715. Finally, data were published reporting hCAP odds ratios for comorbid adults 1.18 (CI: 1.13, 1.23) for diabetes mellitus to 5.48 (CI: 5.28, 5.70) for chronic respiratory disease. In June 2023 the JCVI provided new advice for the adult pneumococcal programme, with a preference for PCV20, to help protect adults aged ³65 years and all adults with certain underlying comorbidities.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences
Depositing User:	Nicola Veasy
Date Deposited:	20 May 2025 08:12
Last Modified:	20 May 2025 08:12
URI:	https://ueaeprints.uea.ac.uk/id/eprint/99306
DOI:

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