Protocol · graded by use, four uses
Pneumococcal vaccination (pneumonia vaccines), for older adults
Invasive pneumococcal disease, 23-valent polysaccharide vaccine, adults.
At a glance
This is about the two pneumonia shots for older adults. In a trial of 84,496 adults 65 and older, the newer shot cut pneumonia from the germ strains it covers by about half. It did not lower pneumonia from all causes, and deaths were the same. The older shot prevented germ infections of the blood and brain in many trials. In wealthy countries it did not lower pneumonia overall or deaths. Sore arms and redness are the most common side effects.
- What was measured
- A first pneumonia caused by the germ strains the vaccine covers, confirmed by lab tests, over about 4 years in adults 65 and older.
- How big
- First pneumonia from the strains the vaccine covers: 49 people on the vaccine against 90 on placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received., 45.6% fewer.Read from the summary of PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 25785969.
- Who it applies to
- Adults 65 and older given the 13-valent conjugate shot, for pneumonia from the strains it covers. It did not lower pneumonia from all causes.
- Safety
- Sore arms, redness and swelling are the common side effects. Serious side effects and deaths were the same as with the dummy shot in the large trial.
- Compared with
- A dummy shot.
- Certainty
- Grade B, resting on: One large placebo-controlled trial of the conjugate vaccine; a Cochrane review of randomized trials of the polysaccharide vaccine.
- What would change this grade
- Could rise to A with: Randomized trial of a pneumococcal vaccine against placebo, run independently of any maker. Who: Adults aged 65 and older in a high-income country. Measured: Culture-confirmed invasive pneumococcal disease, and pneumonia from any cause. Length: At least 2 years.
- Cost
- No price recorded yet.
- Sources
- 3 studies cited on this record, listed under Sources.
The B belongs to one of the four uses graded on this record. The other three carry their own letters.
This record carries a separate letter for each thing it has been measured on. The headline grade is the best of them, and it does not transfer to the others.
Moberley et al. (Cochrane Database Syst Rev, 2013; PMID 23440780): invasive pneumococcal disease odds ratio 0.26 (0.14 to 0.45) across the randomized trials, with no heterogeneity How much the results of the pooled trials differ from each other. High heterogeneity makes a combined estimate less reliable.. Culture-confirmed disease, repeated across independent trials, but many enrolled younger adults or adults in low-income settings and efficacy appeared poorer in adults with chronic illness, so the result is not established in the older adults this record covers: B.
Bonten et al. (N Engl J Med, 2015; PMID 25785969), CAPITA: first vaccine-type community-acquired pneumonia 49 against 90, efficacy 45.6%; vaccine-type invasive disease 7 against 28, efficacy 75.0%; funded by Pfizer, the maker. A laboratory-confirmed disease event in one trial: C under Rule 06 until it is repeated.
Bonten et al. (N Engl J Med, 2015; PMID 25785969): the vaccine did not prevent community-acquired pneumonia from any cause. Tested, no benefit: D on Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale..
Moberley et al. (Cochrane Database Syst Rev, 2013; PMID 23440780): no reduction in all-cause pneumonia in high-income countries and no substantial reduction in all-cause mortality. Tested, no benefit: D on Route 2.
Two kinds of pneumococcal vaccine are given to older adults. The conjugate vaccine lowered pneumonia caused by the strains it covers in one large placebo-controlled trial, but not pneumonia from any cause. The older polysaccharide vaccine prevented invasive pneumococcal disease, infection of the blood or brain, across many trials, but in high-income countries it did not lower pneumonia from any cause or deaths. Graded by use.
Why this letter
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on invasive pneumococcal disease with the 23-valent polysaccharide vaccine: randomized trials pooled by Cochrane found culture-confirmed invasive disease about three quarters less likely, with no disagreement between trials (Moberley et al., 2013; PMID 23440780).
WHY NOT Amany of the pooled trials enrolled younger adults and adults in low-income settings, the review found efficacy appeared poorer in adults with chronic illness, and it did not establish the result in the older adults of high-income countries this record is about. Grade C on pneumonia from the strains the 13-valent conjugate vaccine covers, adults aged 65 and older: one large placebo-controlled trial, 45.6% fewer first episodes (CAPITA; Bonten et al., 2015; PMID 25785969), not repeated. Grade D, tested, on pneumonia from any cause with the conjugate vaccine (PMID 25785969) and on pneumonia from any cause and death with the polysaccharide vaccine in high-income countries (PMID 23440780).
WHAT THIS GRADE DOES NOT COVERthe newer 15-, 20- and 21-valent conjugate vaccines, which were licensed on immune responses and have no efficacy trials in older adults; giving both vaccines in sequence; and children, whose trials are separate.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Who responds: this record's trial reading reports no subgroup that identifies who responds.
Evidence notes: randomized trial, meta-analysis A study that pools the numbers from several trials into one combined estimate., independently replicated The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away., industry-sponsored
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: Invasive pneumococcal disease and pneumococcal pneumonia confirmed by laboratory test, in adults (hard)
Last reviewed: November 2026
The trial that would change this grade.
Positive trials of this shape from independent research groups would move this entry to A.
Why the current trials fall short
The B rests on pooled trials that mostly did not enroll older adults of high-income countries (PMID 23440780). Trials in that population showing invasive disease prevented, repeated by a second group, are what would move the letter to A.
ClinicalTrials.gov, the public registry run by the U.S. National Library of Medicine, lists studies that are recruiting volunteers. The link below searches it for Pneumococcal Vaccine among studies recruiting now. EBL has no relationship with any listed study and receives no payment for this link.
Search recruiting studies of Pneumococcal Vaccine on ClinicalTrials.gov
Dose, form and timing
Measured outcome in the graded trials: first episode of pneumonia or invasive disease caused by the vaccine's strains, confirmed by culture or a strain-specific urine antigen test (CAPITA); invasive pneumococcal disease confirmed by culture, all-cause pneumonia and death (the Cochrane review).
As studiedDose, form, population and duration for every use.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
Safety
Local reactions are the common side effect. In CAPITA, local reactions were more frequent with the conjugate vaccine than placebo, and serious adverse events and deaths were similar in the two groups (Bonten et al., 2015; PMID 25785969). VAERS, the US Vaccine Adverse Event Reporting System, received 25,168 reports after the 23-valent polysaccharide vaccine from 1990 to 2013; 92% were classed non-serious, the most common in adults were injection-site redness, pain and swelling, and there were 66 reports of death, whose clinical review found no pattern suggesting the vaccine caused them (Miller et al., Vaccine, 2016; PMID 27087150). Anyone can file a VAERS report, reports are not verified, and the system does not know how many people were vaccinated, so a report does not show that the vaccine caused the event and the counts are not rates. Its role is to raise signals, which studies with a known number of vaccinated people then measure. The reports can be searched at the system's public site, vaers.hhs.gov.
Cautions documented in human studies. Each caution on this record, sorted by what it rests on.
- Local reactions more frequent with the conjugate vaccine than placebo, with serious adverse events and deaths similar (PMID 25785969)
- VAERS: 25,168 reports after the polysaccharide vaccine, 1990 to 2013, 92% non-serious, 66 death reports, unverified reports that are not rates or proof of cause (PMID 27087150)
None recorded.
None recorded.
Does not apply: human harm data are listed above.
Grade history
How this letter has changedLatest: No. 420 · November 2026 · First graded.
Pneumococcal vaccination now has its own record, graded by use and shown with its harms. Randomized trials of the polysaccharide vaccine pooled by Moberley et al. (Cochrane Database Syst Rev, 2013; PMID 23440780) found invasive pneumococcal disease prevented, but not established in older adults of high-income countries: B; they found no fewer pneumonias from any cause or deaths in high-income countries: D, tested. CAPITA, Bonten et al. (N Engl J Med, 2015; PMID 25785969), found the conjugate vaccine lowered pneumonia from its own strains: C; and not pneumonia from any cause: D, tested. Harms: local reactions in CAPITA and VAERS reports, Miller et al. (Vaccine, 2016; PMID 27087150), with their limits stated.PMID 25785969 PMID 23440780 PMID 27087150
Every change to a letter on this site is dated and published. The full evidence log →
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- November 2026. By a language model (AI-assisted reading), not yet reviewed by a clinician.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
The evidence, in fullThree papers, each linked to its PubMed record.
Bonten et al. (N Engl J Med, 2015; PMID 25785969), CAPITA: 84,496 adults aged 65 and older in the Netherlands, 13-valent pneumococcal conjugate vaccine (PCV13) or placebo, double-blind, mean follow-up 3.97 years; first vaccine-type community-acquired pneumonia 49 against 90 (efficacy 45.6%), vaccine-type invasive disease 7 against 28 (75.0%), community-acquired pneumonia from any cause 747 against 787 (5.1%, not significant); serious adverse events and deaths similar; funded by Pfizer. Moberley et al. (Cochrane Database Syst Rev, 2013; PMID 23440780): 18 randomized trials, 64,852 adults, 23-valent polysaccharide vaccine (PPSV23) and earlier polysaccharide vaccines; invasive pneumococcal disease odds ratio 0.26 (0.14 to 0.45), no heterogeneity; all-cause pneumonia not lowered in high-income countries (0.71, 0.45 to 1.12, general population; 0.93, 0.73 to 1.19, chronic illness); all-cause mortality 0.90 (0.74 to 1.09); efficacy appeared poorer in adults with chronic illness. Harms: CAPITA reported more local reactions with vaccine (PMID 25785969); Miller et al. (Vaccine, 2016; PMID 27087150), VAERS reports after PPSV23, 1990 to 2013, 25,168 reports, 92% non-serious, injection-site redness, pain and swelling most common in adults, 66 death reports with no concerning pattern on review.
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
pneumococcal vaccin*[tiab] AND ("older adults"[tiab] OR elderly[tiab] OR aged[tiab]) AND (pneumonia[tiab] OR invasive[tiab] OR mortality[tiab]) AND (randomized controlled trial[pt] OR meta-analysis[pt])PubMed watch: does a new study change the grade? (nothing new)
No new paper matching the search behind this grade has been added to PubMed since November 2026.
Last run November 2026. A letter on EBL moves only after a logged review. A new paper never moves a letter by arriving: it is read, the answer is written here, and any change to the letter is published in the evidence log.
Disclosure
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
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