Immunogenicity and adverse effects of pneumococcal vaccines co-administered with influenza or SARS-CoV-2 vaccines in adults: A systematic review and Meta-analysis

Background: This systematic review and meta-analysis aimed to investigate the immunogenicity and adverse effects (AEs) of co-administration of pneumococcal vaccines with influenza or SARS-CoV-2 vaccines. Method(s): Following PRISMA 2020 guidelines, we searched MEDLINE, EMBASE, Web of Science, Scopus, and Google for studies published from January 1, 1950, to October 20, 2024. Randomized controlled trials (RCTs) and non-randomized studies were included. Pooled geometric mean titer (GMT) ratios per serotype and risk ratios (RR) for AEs were calculated in the meta-analyses. Result(s): Of 752 search hits, 17 studies were included, consisting of 14 RCTs and three non-randomized studies. One study investigated PCV20 and SARS-CoV-2 vaccine co-administration and found it safe and immunogenic. Six studies examined PPV23 and influenza vaccine co-administration, showing lower immunogenicity for some serotypes but non-inferior to single administration. A meta-analysis of studies on PCV and influenza vaccines showed significantly reduced pooled GMT ratios for several serotypes, with serotype 1 (pooled GMT ratio = 0.74, 95 % CI: [0.63, 0.87]) and 6 A (pooled GMT ratio = 0.78, 95 % CI: [0.71, 0.85]) having the lowest ratios. For AEs, PCV co-administration resulted in a 15 % increase in risk for myalgia/arthralgia (RR: 1.15, 95 % CI: 1.04-1.27) and a 34 % increase for headache (RR: 1.34, 95 % CI: 1.14-1.57). Eight studies were rated as having a moderate or severe risk of bias. Conclusion(s): In adults, co-administration of pneumococcal vaccines with influenza or SARS-CoV-2 vaccines is non-inferior to single-administration; however, it can increase mild-moderate systemic AEs. Data is scarce, and further studies are needed on immunocompromised adults. Copyright © 2024