Risk-based vaccination reveals marked heterogeneity in the clinical benefit of PCV20.
- 1Tel Aviv University
Abstract
Pneumococcal vaccination of older adults is primarily guided by age and clinical eligibility, despite substantial variation in individual risk of severe pneumonia. Here, we used longitudinal electronic health records from 787,538 adults aged ≥65 years to evaluate the real-world effectiveness of the 20-valent pneumococcal conjugate vaccine (PCV20) and quantify clinical benefit according to baseline risk of pneumonia hospitalization. We developed and validated a machine-learning model using pre-PCV20 data to estimate individual 12-month hospitalization risk and integrated these predictions into a propensity score matching framework. Overall vaccine effectiveness against pneumonia hospitalization was 16.5% (95% CI, 10.6– 22.1), but this population-level estimate masked substantial heterogeneity in clinical benefit. The 60% at lowest predicted risk, characterized by younger age and fewer pulmonary and other chronic conditions, showed no measurable reduction in hospitalization (VE, 3.1%; 95% CI, −14.4 to 18.0) and had an estimated 1-year number needed to vaccinate (NNV) of 7,423, compared with 184 and 115 in the intermediate- and high-risk groups, respectively. These findings suggest that incorporating baseline risk into adult pneumococcal vaccination strategies could enable more targeted and potentially better-timed vaccination.
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BibTeX
@misc{markovits2026riskbased,
title = {{Risk-based vaccination reveals marked heterogeneity in the clinical benefit of PCV20.}},
author = {H. Markovits and Y. J. Cohen and D. Grupel and R. Goldstein and H. Goldenstein and N. Katz Hanein and T. Razi and Y. Schonmann and R. Arbel and D. Netzer and S. E. Tsanani and D. Yamin},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.31.26361811},
url = {https://www.medrxiv.org/content/10.64898/2026.08.31.26361811v1},
note = {Public domain},
}
RIS
TY - UNPB
TI - Risk-based vaccination reveals marked heterogeneity in the clinical benefit of PCV20.
AU - H. Markovits
AU - Y. J. Cohen
AU - D. Grupel
AU - R. Goldstein
AU - H. Goldenstein
AU - N. Katz Hanein
AU - T. Razi
AU - Y. Schonmann
AU - R. Arbel
AU - D. Netzer
AU - S. E. Tsanani
AU - D. Yamin
PY - 2026
DA - 2026/08/31
PB - medRxiv
DO - 10.64898/2026.08.31.26361811
UR - https://www.medrxiv.org/content/10.64898/2026.08.31.26361811v1
AB - Pneumococcal vaccination of older adults is primarily guided by age and clinical eligibility, despite substantial variation in individual risk of severe pneumonia. Here, we used longitudinal electronic health records from 787,538 adults aged ≥65 years to evaluate the real-world effectiveness of the 20-valent pneumococcal conjugate vaccine (PCV20) and quantify clinical benefit according to baseline risk of pneumonia hospitalization. We developed and validated a machine-learning model using pre-PCV20 data to estimate individual 12-month hospitalization risk and integrated these predictions into a propensity score matching framework. Overall vaccine effectiveness against pneumonia hospitalization was 16.5% (95% CI, 10.6– 22.1), but this population-level estimate masked substantial heterogeneity in clinical benefit. The 60% at lowest predicted risk, characterized by younger age and fewer pulmonary and other chronic conditions, showed no measurable reduction in hospitalization (VE, 3.1%; 95% CI, −14.4 to 18.0) and had an estimated 1-year number needed to vaccinate (NNV) of 7,423, compared with 184 and 115 in the intermediate- and high-risk groups, respectively. These findings suggest that incorporating baseline risk into adult pneumococcal vaccination strategies could enable more targeted and potentially better-timed vaccination.
ER -