Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature

Figures & data

Figure 1. Recommended pneumococcal vaccinations for adults in 2022, by country (ECDC)²¹.

Figure 2. PRIMSA flow chart depicting the record selection process.

Figure 3. Number of records per country providing a recommendation, per pneumococcal vaccination (as of 2022).

Abbreviations: BE: Belgium, CH: Switzerland, DE: Germany, DK: Denmark, EE: Estonia, ES: Spain; FI: Finland, FR: France, GR: Greece, HU: Hungary, IE: Ireland, IS: Iceland, IT: Italy, LT: Lithuania, LU: Luxembourg, NL: Netherlands, NO: Norway, PL: Poland, PT: Portugal, SK: Slovakia, SI: Slovenia

Table 1. Summary of epidemiology data types included in records for each country.

Abbreviations: Inc. = incidence; Mor. = mortality; StD. = Serotype distribution; %S. = Percent of cases attributable to S. Pneumoniae.

Table 2. Key features of the health economic assessment records.

Country	Author (Ref.)	Analysis type	Intervention	Comparator	Assessment
Austria	Walter et al.^Citation110	BIM	PCV13 or PPV23	None	Positive
Belgium	Marbaix et al.^Citation71	CUA	PCV13	None	Positive
Belgium	Willem et al.^Citation112	CUA	PPV23	PCV13+PPV23	Positive
Denmark	Sevilla et al.^Citation95	CA	PCV13	NR	Positive
Denmark	Birck et al.^Citation41	CEA	PPV23	None	Positive
EU*	Esposito et al.^Citation52	CA	NR	NR	Positive
Finland	THL^Citation103	CEA	NR	NR	NR
France	HCSP^Citation59	CUA	PCV13+PPV23	PPV23	Positive
Germany	Kuchenbecker et al.^Citation67	CEA	PCV13+PPV23	PCV13+PPV23	Positive
Germany	Kuhlmann^Citation36	CUA	PCV13	PCV13+PPV23 or PPV23	Positive
Germany	Storch et al.^Citation100	CA	PCV13 or PPV23	None	Positive
Italy	Boccalini et al.^Citation42	BIM	PCV13	None	Positive
Italy	Sanduzzi et al.^Citation93	BIM	PCV13	None	Positive
Portugal	Gouveia et al.^Citation56	CUA	PCV13 or PPV23	None or PPV23	Positive
Spain	Gomez et al.^Citation55	CUA	PPV23	PCV13+PPV23	Negative
Sweden	Wolff et al.^Citation113	CUA	PSV13	PPV23	Subpop.
Netherlands	Zorginstituut^Citation117	CEA	PCV13 or PPV23	None	Positive
Netherlands	Rozenbaum^Citation90	CUA	PCV13+PPV23	PPV23	Positive
Netherlands	de Vries et al.^Citation50	CUA	PCV13	None	Negative
Netherlands	Thorrington et al.^Citation105	CUA & BIM	PCV13	PPV23	Negative
Netherlands	Zeevat et al.^Citation116	CUA	PCV13	PPV23	Positive
Netherlands	Rozenbaum^Citation91	CUA	PCV13	PPV23	Positive

Abbreviations: BIM = budget impact model; CEA = cost-effectiveness analysis; CUA = cost-utility analysis; CA = cost analysis; EU=Europe; Ref. = reference; Subpop. = subpopulation.

*The review record did not specify which EU countries are included in their synthesis, but cites specific examples and discusses economic rationales for PV use in adults.

Table 3. Included VCR studies with data across time.

Country	Author (Ref.)	Description of population	Type of vaccine	Time period	Coverage rate (%)
Austria	Walter 2019 (110)	adults aged 50+ and at-risk with chronic disease	PPV23 ± PCV13	2018-2023	These are all estimates based on Austrian market research Year 0 (2018): 15% Year 1 (2019): 16% Year 2 (2020): 17% Year 3 (2021): 18% Year 4 (2022): 19% Year 5 (2023): 20%
France	Kopp 2021 (66)	Adults diagnosed with chronic disease (COPD, DM, CHF, and HIV)	PCV13 and PPV23, PPV23	Control period: 2012-2013 Study period: 2013-2017	Overall 2012-2013: 6% 2013-2017: 4% COPD: 2012-2013: 7% 2013-2017: 5% DM: 2012-2013: 2% 2013-2017: 2% CHF: 2012-2013: 7% 2013-2017: 4% HIV: 2012-2013: 16% 2013-2017: 12%
France	Wyplosz 2022 (114)	Adults at risk of pneumococcal diseases	NR	2014-2018	All adults at risk of PD 2014: 464,376 (12.7%) 2015: 365,011 (9.8%) 2016: 354,740 (9.3%) 2017: 337,480 (8.6%) 2018: 182,730 (4.5%) Immunocompromised adults: 2014: 50,298 (10.3%) 2015: 53,132 (10.4%) 2016: 57,130 (10.7%) 2017: 77,405 (13.8%) 2018: 106,977 (18.8%)

Abbreviations: COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; CHF = chronic heart failure; HIV = human immunodeficiency virus

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Data availability statement

All data generated or analyzed during this study are included in this published article (and its supplementary information files).