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PCV13 Effectiveness Study Against Hospitalised VT Pneumococcal CAP in Adults 60 Years and Older

Low Intervention Study of the Effectiveness Of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Against Vaccine Type Pneumococcal Hospitalised Community Acquired Pneumonia (CAP) in Adults 60 Years and Older Using A Test Negative Design Study in A Well-Defined Area of the South of Madrid Region

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT04613375
Enrollment
1821
Registered
2020-11-03
Start date
2021-03-12
Completion date
2024-03-24
Last updated
2025-06-11

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Community Acquired Pneumonia (CAP)

Brief summary

Low interventional, prospective, multicentre, hospital-based study involving adults 60 years of age and older hospitalised with CAP at participating sites.

Detailed description

PCV13 efficacy for the prevention of vaccine-type community-acquired pneumonia (VT-CAP) and invasive pneumococcal disease (IPD) was established in the Community-acquired Pneumonia Immunization Trial in Adults (CAPITA) aged 65 and older. However, there are still few available real-life effectiveness estimates in adults. The aim of this study is to evaluate the PCV13 vaccine effectiveness (VE) against hospitalised VT-pneumococcal CAP among adults aged ≥60 years in the Region of Madrid (Spain). Determination of the effectiveness of PCV13 to prevent hospitalised vaccine-type (VT)-pneumococcal CAP among adults aged ≥60 years in Madrid will be evaluated using a test-negative design study, overall and among immunocompetent persons only.

Interventions

Serotype specific UAD (urinary antigen detection) test

DIAGNOSTIC_TESTSaliva collection

Streptococcus pneumonia identification in saliva samples by culture or PCR / RSV identification in saliva samples by PCR

Sponsors

Pfizer
Lead SponsorINDUSTRY

Study design

Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No

Inclusion criteria

1. Age ≥60 years. 2. Evidence of pneumonia within first 48 hours of hospital admission 3. Evidence of a personally signed and dated informed consent document indicating that the patient (or a legally acceptable representative) has been informed of all pertinent aspects of the study.

Exclusion criteria

1. Any patient who develops signs and symptoms of pneumonia after being hospitalized for ≥48 hours (either at current hospital, another transferring hospital, or a combination of these). 2. Previously enrolled subjects readmitted ≤14 days after discharge for their study qualifying admission. 3. At the time of enrollment, pneumonia has been excluded as the diagnosis or another diagnosis confirmed.

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: OverallApproximately 30 monthsCases were participants with CAP with a valid urinary antigen detection (UAD) result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. VE is reported as part of statistical data in this outcome measure.

Secondary

MeasureTime frameDescription
Percentage of CAP Participants Categorized Per Pneumococcal Serotypes IdentifiedApproximately 30 monthsPercentage of CAP participants in whom streptococcus pneumoniae was identified for PCV13 and 20-valent pneumococcal conjugate vaccine (PCV20) serotypes is reported.
Percentage of CAP Participants in Whom Pneumococcus Identified From Saliva by Culture or Polymerase Chain Reaction (PCR)Approximately 30 monthsRespiratory pneumococcal carriage was determined by testing saliva specimens using both conventional culture and the sensitive molecular method of PCR for the detection of two target genes (lytA and piaB).
Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallApproximately 30 monthsCases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. Data is presented in this outcome by time since vaccination. VE is reported as part of statistical data in this outcome measure.
Percentage of CAP Participants With Underlying at High-Risk Medical ConditionsApproximately 30 monthsHigh-risk medical conditions included: asplenia, cancer/malignancy (hematologic), cancer/malignancy (solid tumor), chronic kidney disease, human immunodeficiency virus (HIV) - acquired immunodeficiency syndrome (AIDS), HIV - No AIDS, immunodeficiency, immunosuppressant drug therapy, multiple myeloma, organ transplantation.
Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistanceApproximately 30 monthsPercentage of SP isolates with antibiotic resistance to penicillin, amoxicillin, cefotaxime, erythromycin, tetracycline, levofloxacin were reported in this outcome measure.
Percentage of CAP Participants With Underlying At-risk Medical ConditionsApproximately 30 monthsAt-risk medical conditions included: alcoholism, asthma, celiac disease, chronic liver disease with hepatic failure, chronic liver disease without hepatic failure, chronic neurologic diseases, chronic obstructive pulmonary disease, coagulation factor replacement therapy, cochlear implant, congestive heart failure, coronary artery disease, cerebrospinal fluid leak, diabetes treated with medication, down syndrome, living in a nursing home, living in a long-term care facility, occupational risk with exposure to metal fumes, other chronic heart disease, other chronic lung disease, other pneumococcal disease risk factors, previous invasive pneumococcal disease, tobacco smoking (tobacco/e-cigarettes).

Countries

Spain

Participant flow

Recruitment details

Participants were evaluated for effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) \[received previously at least 30 days before hospitalization\] in preventing vaccine-type (VT) pneumococcal hospitalized community acquired pneumonia (CAP) among adults aged greater than or equal to (\>=) 60 years in Madrid in this observational study.

Pre-assignment details

A total of 1821 participants were enrolled in this study and 51 participants did not meet inclusion/exclusion of the study. In this study, a) pandemic period included data from 12 March 2021 to 31 July 2022 when last relevant coronavirus disease 2019 (COVID-19) wave in target population (aged \>=60 years) ended in Madrid; b) post-pandemic period included data from 01 August 2022 to 13 September 2023.

Participants by arm

ArmCount
All Participants
Eligible participants who were hospitalized with CAP in one of the study hospitals, their data were observed for effectiveness of PCV13 (received previously, not in this study) in this observational study.
1,770
Total1,770

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyDeath198
Overall StudyWithdrawal by Subject3

Baseline characteristics

CharacteristicAll Participants
Age, Continuous78.08 Years
STANDARD_DEVIATION 9.14
Race and Ethnicity Not Collected— Participants
Sex: Female, Male
Female
761 Participants
Sex: Female, Male
Male
1009 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
198 / 1,680
other
Total, other adverse events
0 / 1,680
serious
Total, serious adverse events
0 / 1,680

Outcome results

Primary

Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: Overall

Cases were participants with CAP with a valid urinary antigen detection (UAD) result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. VE is reported as part of statistical data in this outcome measure.

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: OverallCases105 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: OverallControls1407 Participants
p-value: 0.368595% CI: [-24.43, 44.52]Wald Test
Secondary

Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall

Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. Data is presented in this outcome by time since vaccination. VE is reported as part of statistical data in this outcome measure.

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number Analyzed signifies participants who were evaluable for each category.

ArmMeasureGroupCategoryValue (COUNT_OF_PARTICIPANTS)
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallReceived PCV13 in <2 years or not received PCV13Cases66 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallReceived PCV13 in <2 years or not received PCV13Controls910 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallReceived PCV13 in 2-<5 years or not received PCV13Cases89 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallReceived PCV13 in 2-<5 years or not received PCV13Controls1116 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallReceived PCV13 in >=5 years or not received PCV13Cases66 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: OverallReceived PCV13 in >=5 years or not received PCV13Controls833 Participants
Comparison: \<2 yearsp-value: 0.081795% CI: [-8.9, 76.37]Wald Test
Comparison: 2 years to \<5 yearsp-value: 0.836795% CI: [-50.96, 39.87]Wald Test
Comparison: \>=5 yearsp-value: 0.746995% CI: [-91.53, 59.59]Wald Test
Secondary

Percentage of CAP Participants Categorized Per Pneumococcal Serotypes Identified

Percentage of CAP participants in whom streptococcus pneumoniae was identified for PCV13 and 20-valent pneumococcal conjugate vaccine (PCV20) serotypes is reported.

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.

ArmMeasureGroupValue (NUMBER)
All ParticipantsPercentage of CAP Participants Categorized Per Pneumococcal Serotypes IdentifiedPCV13 Serotypes6.9 Percentage of CAP participants
All ParticipantsPercentage of CAP Participants Categorized Per Pneumococcal Serotypes IdentifiedPCV20 Serotypes13.2 Percentage of CAP participants
Secondary

Percentage of CAP Participants in Whom Pneumococcus Identified From Saliva by Culture or Polymerase Chain Reaction (PCR)

Respiratory pneumococcal carriage was determined by testing saliva specimens using both conventional culture and the sensitive molecular method of PCR for the detection of two target genes (lytA and piaB).

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed signifies participants who had a valid saliva specimen test result.

ArmMeasureValue (NUMBER)
All ParticipantsPercentage of CAP Participants in Whom Pneumococcus Identified From Saliva by Culture or Polymerase Chain Reaction (PCR)11.6 Percentage of CAP participants
Secondary

Percentage of CAP Participants With Underlying at High-Risk Medical Conditions

High-risk medical conditions included: asplenia, cancer/malignancy (hematologic), cancer/malignancy (solid tumor), chronic kidney disease, human immunodeficiency virus (HIV) - acquired immunodeficiency syndrome (AIDS), HIV - No AIDS, immunodeficiency, immunosuppressant drug therapy, multiple myeloma, organ transplantation.

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.

ArmMeasureValue (NUMBER)
All ParticipantsPercentage of CAP Participants With Underlying at High-Risk Medical Conditions35.6 Percentage of CAP participants
Secondary

Percentage of CAP Participants With Underlying At-risk Medical Conditions

At-risk medical conditions included: alcoholism, asthma, celiac disease, chronic liver disease with hepatic failure, chronic liver disease without hepatic failure, chronic neurologic diseases, chronic obstructive pulmonary disease, coagulation factor replacement therapy, cochlear implant, congestive heart failure, coronary artery disease, cerebrospinal fluid leak, diabetes treated with medication, down syndrome, living in a nursing home, living in a long-term care facility, occupational risk with exposure to metal fumes, other chronic heart disease, other chronic lung disease, other pneumococcal disease risk factors, previous invasive pneumococcal disease, tobacco smoking (tobacco/e-cigarettes).

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.

ArmMeasureValue (NUMBER)
All ParticipantsPercentage of CAP Participants With Underlying At-risk Medical Conditions55.2 Percentage of CAP participants
Secondary

Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance

Percentage of SP isolates with antibiotic resistance to penicillin, amoxicillin, cefotaxime, erythromycin, tetracycline, levofloxacin were reported in this outcome measure.

Time frame: Approximately 30 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed = participants in CAP UAD population from whom valid SP isolates were obtained; Number of SP isolates analyzed = number of SP isolates with antimicrobial susceptibility tests performed. Only isolates with antimicrobial susceptibility tests performed were included in analysis.

ArmMeasureGroupValue (NUMBER)
All ParticipantsPercentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistancePenicillin9.1 Percentage of SP isolates
All ParticipantsPercentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistanceAmoxicillin9.1 Percentage of SP isolates
All ParticipantsPercentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistanceCefotaxime3.0 Percentage of SP isolates
All ParticipantsPercentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistanceErythromycin12.1 Percentage of SP isolates
All ParticipantsPercentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistanceTetracycline12.1 Percentage of SP isolates
All ParticipantsPercentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic ResistanceLevofloxacin3.0 Percentage of SP isolates
Post Hoc

Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period

Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. Data is presented in this outcome by time since vaccination. VE is reported as part of statistical data in this outcome measure.

Time frame: Approximately 13.5 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed signifies participants in CAP UAD population for post-pandemic period and Number Analyzed signifies participants who were evaluable for each category.

ArmMeasureGroupCategoryValue (COUNT_OF_PARTICIPANTS)
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic PeriodReceived PCV13 in <2 years or not received PCV13Cases55 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic PeriodReceived PCV13 in <2 years or not received PCV13Controls723 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic PeriodReceived PCV13 in 2-<5 years or not received PCV13Cases79 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic PeriodReceived PCV13 in 2-<5 years or not received PCV13Controls920 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic PeriodReceived PCV13 in >=5 years or not received PCV13Cases57 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic PeriodReceived PCV13 in >=5 years or not received PCV13Controls667 Participants
Comparison: \<2 yearsp-value: 0.02895% CI: [11.86, 89]Wald Test
Comparison: 2 years to \<5 yearsp-value: 0.73895% CI: [-49.73, 43.43]Wald Test
Comparison: \>=5 yearsp-value: 0.432795% CI: [-70.86, 71.37]Wald Test
Post Hoc

Number of Participants Categorized as Cases and Controls to Determine VE of PCV13 Against Hospitalized VT CAP: Post-Pandemic Period

Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. VE is reported as part of statistical data in this outcome measure.

Time frame: Approximately 13.5 months

Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed signifies participants in CAP UAD population for post-pandemic period.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine VE of PCV13 Against Hospitalized VT CAP: Post-Pandemic PeriodCases89 Participants
All ParticipantsNumber of Participants Categorized as Cases and Controls to Determine VE of PCV13 Against Hospitalized VT CAP: Post-Pandemic PeriodControls1152 Participants
p-value: 0.182795% CI: [-15.21, 52.42]Wald Test

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026