High Pneumococcal Disease Burden Persists Among Adults Over 65

A continuous unmet need remains among French adults aged 65 or older, as the pneumococcal disease (PD) burden is substantial among this population, according to study data published in Human Vaccines & Immunotherapeutics.¹ The researchers’ results helped them provide support for the recent recommendation change of increasing pneumococcal vaccination ages to all patients aged 65 and older.

“PD affects people of all ages, but young children (≤5 years of age, and especially those ≤2 years of age) and adults 65 years [or older] are at higher risk of PD or experiencing severe disease than other age groups,” wrote the authors of the study. “Furthermore, adults with underlying medical conditions (UMCs), including chronic diseases or immunocompromising illnesses, have a higher likelihood of developing PD than those without UMCs, potentially leading to greater rates of hospitalization and mortality.”

PD, caused by Streptococcus pneumoniae, can be categorized as either invasive (e.g., meningitis, bacteremia, and bacteremic pneumonia), or noninvasive (e.g., bronchitis, otitis media, and sinusitis), according to study authors. | image credit: Ольга Лукьяненко / stock.adobe.com

PD is known to impact at-risk populations, and it manifests in 2 different types: invasive and noninvasive PD.¹ Both are prominent among various populations. In findings from a study published in the Journal of Infectious Diseases, researchers reported that rates of invasive and noninvasive PD were significant from 2010 to 2018.²

READ MORE: Pneumococcal Vaccine Rates Low Despite Updated Recommendations

Furthermore, focusing specifically on noninvasive PD, additional research findings show that noninvasive pneumococcal community-acquired pneumonia remains a significant burden despite the widespread introduction of pneumococcal vaccines. This study explored data from January 1990 to March 2021.³

Researchers of the current study, however, focused on the overall PD burden within a specific location: France. The current standard of care for preventing PD among medium- or high-risk adults since 2023 has been the 20-valent pneumococcal conjugate vaccine (PCV20). In January 2025, the PCV20 recommendation was expanded to all adults 65 years or older.¹

Despite data from the current study showing low rates of pneumococcal vaccination at 4.5% in 2018, those rates have since increased, reported at 19% of patients in France from 2016 to 2022.⁴ Amid the ongoing trends in PD and pneumococcal vaccination rates, researchers assessed patients’ PD burden in France over 4 years.

“To understand the extent of PD and its impact on public health, an assessment of the current PD landscape in France is considered crucial,” said the authors.¹ “This retrospective cohort study used data from the national health care data system to assess pneumococcal vaccination patterns and vaccine coverage and estimate the clinical and economic burden of PD in adults 18 years [and older] in France, by age group and by health risk status.”

The researchers’ cohort study consisted of adults in France aged 18 or older from January 1, 2015, through December 31, 2018. To determine the official PD burden in France, they estimated in-patient PD incidence and the factors associated with mortality among this population.

The study consisted of 2 separate cohorts. Patients with UMCs, whether they had PD or not, were considered the UMC population. Those with PD leading to hospitalization were included in the inpatient PD population group. The final cohort analysis included 7,947,622 patients in the UMC population (mean age, 65 years; 50.8% women) and 41,885 in the inpatient PD population group (59.6% were 65 or older).

“From 2015 to 2018, there was a notable increase in the absolute number of inpatient PD episodes, indicating a growing burden of PD among French adults,” they wrote.¹ “The highest incidence of inpatient PD episodes was observed among adults ≥65 years of age (regardless of risk group) and among adults with UMCs.”

The incidence of inpatient PD episodes in the UMC population was 121.98 per 100,000 person-years, and in the overall study population, it was 4.82 episodes per 100,000 person-years. Furthermore, when investigators collectively observed the overall population, individuals with at least 1 UMC held a 15-fold increased risk of inpatient IPD.

With a persistent PD burden in this area of the world, despite expanded vaccine technology, this study reinforces the need for a revamp of France’s immunization efforts for PDs. As at-risk groups go unvaccinated and older adults experience increased hospitalization, the importance of early diagnosis, appropriate management, and targeted preventive strategies has increased substantially within the PD space.

“Our findings support the recent expansion of vaccination to all individuals ≥65 years of age, regardless of health risk status,” concluded the authors.¹ “The role of further preventive measures against PD, such as the implementation of health insurance vouchers and the simultaneous administration of influenza and pneumococcal vaccines for older adults, [is an] important area of future inquiry.”

READ MORE: Pneumococcal Resource Center

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References

1. Bailey MD, Farge G, Mohanty S, et al. Clinical burden of pneumococcal disease among adults in France: a retrospective cohort study. Hum Vaccin Immunother. 2025;21(1). https://doi.org/10.1080/21645515.2025.2515760

2. López-Lacort M, Amini M, Emborg HD, et al. Incidence of invasive and noninvasive pneumococcal pneumonia hospitalizations in people aged ≥50 years: assessing variability across Denmark and Spain. J Infect Dis. 2024;230(3):e559-e567. https://doi.org/10.1093/infdis/jiae088

3. Lansbury L, Lim B, McKeever TM, et al. Non-invasive pneumococcal pneumonia due to vaccine serotypes: a systematic review and meta-analysis. EClinicalMedicine. 2022;44:101271. doi:10.1016/j.eclinm.2022.101271

4. Rolland S, Nguyen LL, Descamps A, et al. Influenza and pneumococcal vaccine coverage among adults hospitalised with acute respiratory infection in France: a prospective cohort study. IJID. 2025;153:107811. https://doi.org/10.1016/j.ijid.2025.107811