Research and analysis

Pneumococcal polysaccharide vaccine (PPV): coverage report, England, April 2023 to March 2024

Updated 31 March 2025

Applies to England

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This publication is available at https://www.gov.uk/government/publications/pneumococcal-polysaccharide-vaccine-ppv-vaccine-coverage-estimates/pneumococcal-polysaccharide-vaccine-ppv-coverage-report-england-april-2023-to-march-2024

Main points

This annual report presents Pneumococcal Polysaccharide Vaccine (PPV) coverage and uptake data by age group and clinical risk group from April 2023 to March 2024. This report is based on data from 40.0% of general practitioner (GP) practices [see Note 1].

The main findings were that:

  • coverage in those aged 65 and over was 73.1%, an increase of 1.3 percentage points compared with the 2022/23 financial year

  • coverage increased with age from 34.8% in those aged 65 to 85.3% in those aged 75 and over

  • coverage in those aged 2 to 64 in one or more clinical risk group was 46.5%

  • coverage in clinical risk groups ranged from 34.3% (chronic liver disease) to 84.2% (cochlear implants)

  • uptake since April 2023 was 4.8% in those aged 65 and over and was highest in younger age groups who became eligible more recently

Note 1. This report only includes data from one GP IT supplier, due to data quality issues.

Introduction

Pneumococcal disease can present as non-invasive or invasive infections caused by the bacterium Streptococcus pneumoniae (also called pneumococcus). Non-invasive disease includes middle ear infections (otitis media), sinusitis and bronchitis, whilst invasive pneumococcal disease (IPD) includes septicaemia, pneumonia and meningitis.

IPD is a significant cause of morbidity and mortality globally and in the UK with more than 4,500 confirmed cases reported in 2022/23 in England (1). Pneumococcal immunisation is currently offered to young children, the elderly (people aged 65 years and over) and individuals with certain medical conditions – because these groups are at the highest risk of IPD (2).

Pneumococcal immunisation has been recommended for clinical risk groups since 1992 (2). The pneumococcal immunisation programme was introduced in the UK in August 2003 and offered a single dose of PPV to people aged 80 years and over in addition to those at high risk under 65 years of age (2). In April 2004, the programme was expanded to include all people aged 75 years and over. Since April 2005, all people aged 65 years and over have been eligible for the vaccine.

PPV (also currently known as PPV23) is an inactivated vaccine that contains purified polysaccharide from 23 capsular pneumococcus types, including the 10 most prevalent serotypes: 14, 9V, 1, 8, 23F, 4, 3, 6B, 19F and 7F. Most healthy adults develop a good antibody response to a single dose of PPV (2). Among people aged 65 years and over, PPV offers moderate short-term protection against IPD caused by the 23 serotypes targeted by the vaccine (3). In contrast, children younger than 2 years of age show poor antibody response to vaccination with PPV and there is no evidence to support effectiveness of the vaccine among this population group (2). Children younger than 2 years of age are therefore offered a pneumococcal conjugate vaccine (PCV13) through the childhood immunisation programme. Further information on PPV vaccine eligibility is available in ‘Immunisation against infectious disease’ (the Green Book) (2).

This report describes vaccine coverage and uptake of the pneumococcal polysaccharide vaccine (PPV) programme in England. The report includes data from adults aged 65 years and over and individuals aged 2 to 64 years in 9 clinical risk groups associated with elevated risk of adverse outcomes of pneumococcal disease. The current report presents vaccine coverage and uptake estimates for the period between 1 April 2023 to 31 March 2024.

Methods

Data sources

The current report presents PPV coverage and uptake estimates among GP-registered individuals in England.

GP IT suppliers used a standardised script to automatically extract GP-level data from medical records of individuals who were registered with a GP in England on the last day of the collection period, which was 31 March 2024.

This data was automatically uploaded to the ImmForm website and was then validated and analysed by the UK Health Security Agency (UKHSA) to check data completeness, identify anomalous data and describe epidemiological trends.

Data collected

The number of individuals registered with the GP and the number vaccinated with PPV were captured by age group, clinical risk group and gender. Data is presented for those who were eligible for the vaccine which includes those aged 65 and over and those aged 2 to 64 in clinical risk groups, as described below.

Age groups

The age groups included are:

  • 65 years
  • 66 years
  • 67 years
  • 68 years
  • 69 years
  • 70 to 74 years
  • 65 years and over
  • 75 years and over

Clinical risk groups

The clinical risk groups included are:

  • asplenia
  • chronic respiratory disease
  • chronic heart disease
  • chronic kidney disease
  • chronic liver disease
  • diabetes requiring insulin or oral hypoglycaemic medication
  • immunosuppression
  • cochlear implants
  • cerebrospinal fluid leak

Gender groups

The gender groups included are:

  • men
  • women
  • gender unknown
  • total (all genders)

Gender unknown includes individuals whose gender was coded as ‘Gender – unknown’ or ‘Gender – unspecified’.

Definitions of ‘uptake’ and ‘coverage’

This report includes figures for vaccine uptake and coverage. Coverage measures the proportion of the eligible population who have received the vaccine at any time. This measure shows the overall level of protection in the group. Uptake measures the proportion of the eligible population who have received the vaccine in the past year. This measure shows the level of recent vaccination activity and can be used to estimate how soon after becoming eligible individuals receive the vaccine.

For clinical risk groups we report coverage in all patients registered as ‘at risk’ to assess the overall level of protection in those at higher risk of adverse outcomes from IPD. We also report uptake in those who have recently become ‘at risk’ to assess the timeliness of vaccination.

Vaccine coverage among individuals aged 65 years and over

This is the percentage of GP-registered individuals who were 65 years and over on 31 March 2024 and who received PPV any time on or before 31 March 2024.

Vaccine uptake among individuals aged 65 years and over

This is the percentage of GP-registered individuals who were 65 years and over on 31 March 2024 and who received PPV between 1 April 2023 and 31 March 2024.

Vaccine coverage among individuals aged 2 to 64 years in one or more clinical risk groups

This is the percentage of GP-registered individuals, who were 2 to 64 years old on 31 March 2024, who were in one or more clinical risk groups on 31 March 2024 and who received PPV any time on or before 31 March 2024

Vaccine uptake among individuals aged 2 to 64 years newly in one or more clinical risk groups

This is the percentage of GP-registered individuals, who were 2 to 64 years old on 31 March 2024, who joined one or more clinical risk groups between 1 April 2022 and 31 March 2023 and who received PPV between 1 April 2022 and 31 March 2024

Vaccine coverage among individuals aged 2 to 64 years in individual clinical risk groups

This is the percentage of GP-registered individuals, who were 2 to 64 years old on 31 March 2024, who were in an individual clinical risk group on 31 March 2024, and who received PPV any time on or before 31 March 2024

Vaccine uptake among individuals aged 2 to 64 years newly in individual clinical risk groups

This is the percentage of GP-registered individuals, who were 2 to 64 years old on 31 March 2024, who joined an individual risk group between 1 April 2022 and 31 March 2023 and who received PPV between 1 April 2022 and 31 March 2024.

Further notes about coverage and uptake data

It should be noted that:

  • vaccine coverage and uptake among individuals aged 65 years and over are presented overall and by age group and gender
  • vaccination coverage and uptake among individuals aged 2 to 64 years in one or more clinical risk groups are presented overall and by gender; for this measure, individuals in multiple clinical risk groups were only counted once
  • vaccination coverage among individuals aged 2 to 64 years is also presented for individual clinical risk groups; for this measure, individuals in multiple clinical risk groups were counted multiple times

Because of the above, the total number of ‘at risk’ individuals by individual clinical risk group is not directly comparable to the number of ‘at risk’ individuals overall and by gender.

Results

Response summary

The figures presented in this report currently include data from 40.0% (2,531 out of 6,331) of GPs. Data from one GP IT supplier was excluded due to data quality issues and is currently under review.

Coverage and uptake among individuals aged 65 and over

PPV coverage by age group

Coverage is the proportion of those aged 65 and over who have been vaccinated at any time. This provides an indicator of overall protection in these age groups.

PPV coverage was 73.1% among those aged 65 and over (Table 1). Coverage gradually increased with age, rising from 34.8% in those aged 65 to 85.3% in those aged 75 and over (Figure 1). Coverage in those over 65 in 2023 to 2024 remains similar to previous year, increasing by 1.3 percentage points since the 2022 to 2023 financial year (Figure 2).

Table 1.  PPV vaccine coverage and uptake among individuals aged 65 and over on 31 March 2024, by age group in England

Age group Number registered on 31 March 2024 Number vaccinated between 1 April 2023 and 31 March 2024 PPV uptake (%) Number vaccinated on or before 31 March 2024 PPV coverage (%)
65    290,516    45,703    15.7    101,017    34.8
66    281,507    33,975    12.1    126,753    45.0
67    267,479    22,788    8.5    138,465    51.8
68    255,709    17,658    6.9    148,487    58.1
69    247,697    14,586    5.9    155,224    62.7
70    246,599    18,203    7.4    168,558    68.4
71    237,678    13,658    5.7    171,622    72.2
72    231,451    9,760    4.2    172,540    74.5
73    229,725    8,281    3.6    175,926    76.6
74    233,774    7,310    3.1    183,488    78.5
75 and over    2,448,588    46,216    1.9    2,089,724    85.3
Total 4,970,723    238,138    4.8    3,631,804    73.1

Figure 1. PPV vaccine uptake and coverage among individuals aged 65 and over on 31 March 2024, by age group in England

PPV uptake by age group

Uptake is the proportion of those aged 65 and over who have been vaccinated in the last year. This provides an indicator of vaccination activity in the 2023 to 2024 financial year and shows how long after becoming eligible individuals are receiving the vaccine.

Uptake was 15.7% in those aged 65 who had recently become eligible for the vaccine (Table 1). Uptake decreased with age, falling to 1.9% in those aged 75 and over (Figure 1). The only exception to this trend was in 70 year olds whose uptake was 7.4%, which was higher than the uptake in those aged 68 (6.9%) and 69 (5.9%).

Uptake in those aged 65 and over remains similar to previous years, with uptake increasing from 4.5% in the 2022 to 2023 financial year, to 4.8% in the 2023 to 2024 financial year Figure 3).

PPV coverage and uptake by gender

Among individuals aged 65 years and over, coverage was 73.5% for women and 72.6% for men. Since April 2023, the uptake in this age group was 4.7% for women and 4.9% for men (Table 2).

Table 2: PPV coverage and uptake among individuals aged 65 and over on 31 March 2024, by gender, in England

Gender Number registered on 31 March 2024 Number vaccinated between 1 April 2023 and 31 March 2024 PPV uptake (%) Number vaccinated on or before 31 March 2024 PPV coverage (%)
Male 2,302,281 112,522 4.9 1,670,380 72.6
Female 2,668,405 125,614,000 4.7 1,961,405 73.5
Gender unkown [Note 3] 37 2 5.4 19 51.4
Total 4,970,723 238,138 4.8 3,631,804 73.1

Note 3. Gender unknown includes individuals whose gender is coded as ‘Gender – unknown’ or ‘Gender – unspecified’

Coverage and uptake among individuals aged 2 to 64 in clinical risk groups

Coverage among individuals aged 2 to 64 in clinical risk groups

Coverage for those in a clinical risk group is the proportion of those aged 2 to 64 registered as at risk who have been vaccinated at any time. This provides an indicator of overall protection in all at risk patients.

Overall coverage among individuals aged 2 to 64 years in one or more clinical risk groups was 46.5%. Coverage in individual risk groups ranged from 34.3% in those with Chronic Liver Disease to 84.2% in those with Cochlear Implants (Table 3).

Table 3. PPV vaccine coverage and uptake among individuals aged 2 to 64 on 31 March 2024, by individual risk group, in England

Clinical risk group Number vaccinated between 1 April 2022 and 31 March 2024 Number newly-registered as ‘at risk’ between 1 April 2022 and 31 March 2023 PPV uptake (%) Number vaccinated on or before 31 March 2024 Number registered as ‘at risk’ on 31 March 2024 PPV coverage (%)
Asplenia / dysfunction of the spleen 1,196    4,266      28.0     63,158    109,493      57.7
Chronic respiratory disease  4,955    18,167      27.3     136,381    260,431      52.4
Chronic heart disease  3,836    23,105      16.6     145,494    312,618      46.5
Chronic kidney disease 209    1,337      15.6     21,462    38,416      55.9
Chronic liver disease  581    6,247      9.3     29,366    85,601      34.3
Diabetes requiring insulin or oral hypoglycaemic medication 11,897    56,950      20.9     373,119    706,414      52.8
Immuno-suppression  5,001    23,892      20.9     19,9657    459,531      43.4 
Cochlear implants  45    107      42.1    4,234      5,031      84.2 
Cerebrospinal fluid leaks  16       97      16.5     1,671    3,374      49.5

Uptake among individuals aged 2 to 64 newly in clinical risk groups

Uptake for those newly in a clinical risk group is the proportion of those aged 2 to 64 who have newly become at risk who have been vaccinated recently in the last year. This provides an indicator of the timeliness of vaccination as it shows whether individuals are receiving their vaccination soon after becoming at risk.

Overall uptake among individuals aged 2 to 64 years newly entering one or more clinical risk groups was 20.5%. Uptake in individual risk groups ranged from 9.3% in those with Chronic Liver Disease to 42.1% in those with Cochlear Implants (Table 3).

PPV coverage and uptake in those aged 2 to 64 in clinical risk groups, by gender

Among individuals in one or more at risk groups, coverage was 45.7% for men and 47.5% for women. Uptake since April 2023 was 19.3% among men and 21.9% among women (Table 4).

Table 4.  PPV vaccine coverage and uptake among individuals aged 2 to 64, in one or more risk grops, on 31 March 2024, gender in England

Gender Number vaccinated between 1 April 2022 and 31 March 2024 Number newly-registered as ‘at risk’ between 1 April 2022 and 31 March 2023 PPV uptake (%) Number vaccinated on or before 31 March 2024 Number registered as ‘at risk’ on 31 March 2024 PPV coverage (%)
Male 13,686 70,860 19.3 412,956 903,314 45.7
Female 13,125 59,952 21.9 379,970 800,689 47.5
Gender unknown [Note 3] 0 3 0 23 60 38.3
Total 26,811 130,815 20.5 792,949 1,704,063 46.5

Note 3. Gender unknown includes individuals whose gender is coded as ‘Gender – unknown’ or ‘Gender – unspecified’

Discussion

The current analysis used data from 40.0% (2,531 out of 6,331) of GPs as one GP IT supplier was excluded due to data quality issues. This means that regional breakdowns cannot be provided and that the figures presented should be regarded as provisional and approximately representative of England as a whole until validated data is available from both GP IT system suppliers. Coverage in those aged 65 and over was 73.1%, an increase of 1.3 percentage points compared with the 2022 to 2023 financial year. For those in clinical risk groups aged 2 to 64, coverage was 46.5% and coverage varied substantially by individual clinical risk group.

Coverage increased with age, as individuals had more time to be vaccinated. This trend demonstrates that PPV continues to be offered opportunistically in primary care to individuals aged 65 years and over who remain eligible as they age.

Uptake is expected to be lower in older age groups as older individuals have been eligible for longer so are more likely to have had the vaccine prior to the most recent 12 months in which uptake is measured. However, in 2023 to 2024, uptake in those aged 70 (7.4%) was higher than those aged 68 (6.9%) and 69 (5.9%). This trend may be because those aged 70 would have also recently become eligible for the new Shingrix vaccine and may have been offered the PPV vaccine opportunistically alongside Shingrix.

Coverage by gender was marginally higher in females (73.5%) than in males (72.6%). This was also the case for individuals aged 2 to 64 years in one or more clinical risk groups where vaccine coverage was 47.5% in females and 45.7% in males.

Coverage by clinical risk group varied from 34.3% (chronic liver disease) to 84.2% (cochlear implants), although the number of people with cochlear implants is smaller. The differences in coverage among individuals in clinical risk groups may suggest that awareness of eligibility and importance of PPV among individuals and clinicians may vary substantially according to clinical risk. Due to the ambiguity of certain clinical codes, there will be individuals eligible for vaccination in clinical risk groups who are not included in these estimates.

References

1. Bertran M, D’Aeth JC, Abdullahi F, Eletu S, Andrews NJ, Ramsay ME, and others (2024). Invasive pneumococcal disease 3 years after introduction of a reduced 1 + 1 infant 13-valent pneumococcal conjugate vaccine immunisation schedule in England: a prospective national observational surveillance study. The Lancet Infectious Diseases: volume 24, issue 5, pages 546 to 556

2. UKHSA and DHSC. ‘Immunisation against infectious disease, chapter 25: Pneumoccal’ (the Green Book)

3. Djennad A, Ramsay ME, Pebody R and others (2018). ‘Effectiveness of 23-valent Polysaccharide Pneumococcal Vaccine and changes in invasive pneumococcal disease incidence from 2000 to 2017 in those aged 65 and over in England and Wales’. EClinicalMedicine: volume 6, pages 42 to 50

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