PCV13/PPSV23 Co-vaccination versus PPSV23 Monotherapy for the Prevention of Pneumococcal Infections: A Systematic Review and Meta-analysis

Yuri Matsumoto; Takayuki Mihara; Yuko Okamoto; Ayu Tsubouchi; Shintaro Ikegami; Mishu Takahashi; Kanon Nakabayashi; Naoto Nishimoto; Yuki Mizukami; Takuma Muraishi; Yuki Igarashi; Yuki Enoki; Kazuaki Taguchi; Kazuaki Matsumoto

doi:10.1248/bpb.b25-00769

Regular Article

PCV13/PPSV23 Co-vaccination versus PPSV23 Monotherapy for the Prevention of Pneumococcal Infections: A Systematic Review and Meta-analysis

Yuri Matsumoto ^†, Takayuki Mihara ^†, Yuko Okamoto , Ayu Tsubouchi, Shintaro Ikegami, Mishu Takahashi, Kanon Nakabayashi, Naoto Nishimoto, Yuki Mizukami, Takuma Muraishi, Yuki Igarashi, Yuki Enoki , Kazuaki Taguchi, Kazuaki Matsumoto

Author information

Yuri Matsumoto ^†
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Takayuki Mihara ^†
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Yuko Okamoto Corresponding author
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Ayu Tsubouchi
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Shintaro Ikegami
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Mishu Takahashi
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Kanon Nakabayashi
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Naoto Nishimoto
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Yuki Mizukami
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Takuma Muraishi
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Yuki Igarashi
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Yuki Enoki Corresponding author
https://orcid.org/0000-0002-5934-0670
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Kazuaki Taguchi
Department of Clinical Pharmacotherapy, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1–2–3 Kasumi, Minami-ku, Hiroshima 734–8553, Japan
Kazuaki Matsumoto
Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, 1–5–30 Shibakoen, Minato-ku, Tokyo 105–8512, Japan
Author contributions

†These authors contributed equally: Yuri Matsumoto, Takayuki Mihara

Keywords: pneumococcal infection, 13-valent pneumococcal conjugate vaccine (PCV13), 23-valent pneumococcal polysaccharide vaccine (PPSV23), co-vaccination, opsonophagocytic activity geometric mean titer ratio (OPA GMTR), older adult

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Supplementary material

2026 Volume 49 Issue 4 Pages 666-682

DOI https://doi.org/10.1248/bpb.b25-00769

Details

Abstract

The 23-valent pneumococcal polysaccharide (PPSV23) and 13-valent pneumococcal conjugate (PCV13) vaccines are available for the prevention of infections caused by Streptococcus pneumoniae. This systematic review and meta-analysis evaluated the immunogenicity and safety of PPSV23 and PCV13 co-vaccination (PCV13/PPSV23) compared with PPSV23 monotherapy in adult populations. PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing PCV13/PPSV23 co-vaccination with PPSV23 monotherapy published until September 15, 2023. Immunogenicity was assessed using the geometric mean titer ratio (GMTR) of opsonophagocytic activity (OPA), which reflects bactericidal activity against each serotype. The safety outcomes included local and systemic adverse events. The risk ratios and 95% confidence intervals were calculated using the inverse variance-weighted method. The meta-analysis included 4 RCTs involving 2739 participants. The OPA GMTRs for 11 of the 13 evaluated serotypes were significantly higher in the PCV13/PPSV23 group than those in the PPSV23 group. The safety analysis showed no statistically significant differences in the incidence of adverse events between the 2 groups across all assessed outcomes. PCV13/PPSV23 showed significantly higher immunogenicity against the pneumococcal serotypes and maintained a safety profile comparable to that of PPSV23. These results support the potential utility of PCV13/PPSV23 as an effective strategy for preventing pneumococcal diseases in older adults.

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