Evaluating the Association between Routine Pneumococcal Vaccination and COVID-19 Severity among Older Adults in the United States

BackgroundThe relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Streptococcus pneumoniae remains uncertain. This study investigates the association between routine pneumococcal vaccination and the progression to severe COVID-19 outcomes in a cohort of older adults in the United States. MethodsOur cohort study includes adults aged 65 and older from a subset of adults covered by Medicare in the United States with a documented COVID-19 diagnosis. Logistic regression models were employed to assess the association between pneumococcal vaccination (13-valent conjugate vaccine [PCV13] and 23-valent pneumococcal polysaccharide vaccine [PPSV23]) and COVID-19 severity. ResultsAmong 90,070 Medicare enrollees with a COVID-19 diagnosis, 28,124 individuals exhibited severe respiratory symptoms or were admitted to the intensive care unit (ICU). The odds ratio (OR) for progression from non-severe symptoms to respiratory symptoms with or without ICU admission with prior PCV13 receipt was 0.91 (95% confidence interval [CI], 0.88, 0.93), the OR for progression from severe respiratory symptoms to ICU critical care with prior PCV13 receipt was 0.92 (95% CI, 0.88, 0.97), and the OR for progression from non-severe symptoms to ICU critical care with prior PCV13 receipt was 0.85 (95% CI, 0.81, 0.90). There was no association between PPSV23 received more than five years before the COVID-19 diagnosis and the COVID-19 outcomes. ConclusionsOverall, our findings indicate moderate to no association between PCV vaccination and COVID-19 severity.