PONE-D-24-58613-->-->Will vaccination of adults aged 65 years help to increase pneumococcal vaccination coverage in the at-risk population? A review of the evidence from a retrospective population-based study in France.-->-->PLOS ONE?>

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[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1:  Congratulations on a well crafted article that addresses a very important issue.

The article is well written, technical sound and addresses the objectives of the study. The only revision I would recommend is that of the title which is a bit 'wordy' and ambigous.

Reviewer #2:  The manuscript explores the factors associated with pneumococcal vaccination among older adults in France using population-level data. Overall, the study is well-structured and uses robust data sources and statistical methods. However, I recommend conducting additional sensitivity analyses and addressing several minor errors to enhance the manuscript.

Major Revisions:

Methods:

1. On Page 7, line 134: Please clarify whether the definition of vaccination coverage includes participants who are only partially vaccinated, such as those who received one dose of PCV13 or PPV23, or those who received two doses but did not follow the recommended schedule. If these participants are not included in the current definition, conducting a sensitivity analysis to explore their impact would be useful.

Results:

1. I recommend providing more interpretable explanations of the Odds Ratios (OR) alongside their categorization as negative, small, medium, or large effects. For instance, on line 265, the OR for "2 comorbidities" can be presented as: Individuals with two comorbidities are 2.26 times [95% CI] more likely to be vaccinated than those with one comorbidity, after adjusting for other specified variables. Furthermore, the effect is even more pronounced (OR = 3.75 [95% CI]) for those with three or more comorbidities compared to those with one comorbidity. You don't need to interpret every OR, but offering a clear interpretation for at least one OR in each effect category would help guide the audience through the results section.

Minor Revisions:

1. Page 3, line 33: Please specify the validated algorithms used in your analysis.

2. Page 4, line 58: I suggest incorporating data from the following reference for additional background on the global and France-specific incidence of invasive pneumococcal disease (IPD) by age: DOI:10.1016/S1473-3099(24)00665-0. Also, on line 67, remove the period before the reference.

3. Page 5, line 79: Spell out "EEA" when first mentioned. Additionally, on line 86, please specify the denominator for the statistic mentioned; consider adding the total number of adults in the French population. On line 90, spell out "GP."

4. Page 8, lines 150-156: The rationale for using OR in a large population-level study may be evident to readers with an epidemiology background. Consider moving this justification to the supplementary materials if you feel it is necessary to include.

5. Page 14, line 264: Correct "CI95%" to "95% CI."

6. Address any additional grammar and formatting issues, which may be better handled by the journal's editorial team during the final review process.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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Pneumococcal vaccination at 65 years and vaccination coverage in at-risk adults: A retrospective population-based study in France.

PONE-D-24-58613R1

Dear Dr. Wyplosz,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

David J. Diemert, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: Yes

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Reviewer #2: The authors have thoroughly addressed the comments raised during the initial review, and the revised manuscript reflects significant improvements in clarity, methodological detail, and interpretability of the results. The addition of more interpretable interpretations of the odds ratios, clarification of vaccination coverage definitions, incorporation of relevant external references, and attention to minor formatting and editorial suggestions demonstrate the authors' responsiveness and commitment to improving the manuscript.

Notably, the updated analyses and clearer explanations provide compelling support for the authors' conclusion that an age-based recommendation for pneumococcal vaccination (as currently done for influenza in France) may enhance vaccine coverage among at-risk adults. The large, population-based dataset, along with the well-justified statistical approach, offers robust and policy-relevant findings.

Given that all major and minor concerns have been adequately addressed, I recommend acceptance of this revised version for publication.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #2: No

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