Drugs & Aging

, Volume 15, Supplement 1, pp 21–30 | Cite as

Pneumococcal Vaccination for Older Adults

The First 20 Years
Review Article

Abstract

During the 20 years following its licensure, pneumococcal vaccine has not been widely used. Although the vaccine was shown to be efficacious in South African gold miners, clinical trials of ‘pneumonia vaccine’ in older adults that have attempted to demonstrate vaccine efficacy in preventing pneumonia have been inconclusive. Retrospective studies have convincingly demonstrated the effectiveness of vaccination in preventing invasive pneumococcal disease, but these findings have only gradually gained acceptance, largely because some observers reject the findings of observational studies or fail to appreciate the importance of invasive disease. In the 1980s, pneumococcal vaccine was used only in the US, but other countries began vaccination in the mid-1990s, in part due to a better understanding of the disease and the vaccine, but also because of concern about antimicrobial resistance. With greater understanding of the global importance of pneumococcal disease and the promise of conjugate and protein vaccines, during the next 20 years pneumococcal vaccines will become the most important vaccines for adults and children worldwide.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kane RL, Grimley Evans JG, Macfayden D, editors. Improving the health of older people. Published on behalf of the World Health Organization. Oxford: Oxford University Press, 1990: 323Google Scholar
  2. 2.
    Austrian R, Douglas RM, Schiffman G, et al. Prevention of pneumococcal pneumonia by vaccination. Trans Assoc Am Physicians 1976; 89: 184–94PubMedGoogle Scholar
  3. 3.
    Smit P, Oberholzer D, Hayden-Smith S, et al. Protective efficacy of pneumococcal polysaccharide vaccines. JAMA 1977; 238: 2613–6PubMedCrossRefGoogle Scholar
  4. 4.
    Gaillat J, Zmirou D, Mallaret M, et al. Clinical trial of pneumococcal vaccine among institutionalized elderly [French]. Rev Epidémiol Santé Publique 1985; 33: 437–44PubMedGoogle Scholar
  5. 5.
    Simberkoff MS, Cross AP, Ai-Ibrahim M, et al. Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study. N Engl J Med 1986; 315: 1318–27PubMedCrossRefGoogle Scholar
  6. 6.
    Koivula I, Stén M, Leinonen M, et al. Clinical efficacy of pneumococcal vaccine in the elderly: a randomized, single-blind population-based trial. Am J Med 1997; 103: 281–90PubMedCrossRefGoogle Scholar
  7. 7.
    Ortqvist A, Hedlund J, Burman LA, et al. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish Pneumococcal Vaccination Study Group. Lancet 1998; 351: 399–403PubMedCrossRefGoogle Scholar
  8. 8.
    Fedson DS, Musher DM, Eskola J. Pneumococcal vaccine. In: Plotkin SA, Orenstein WA, editors. Vaccines. 3rd ed. Philadelphia: WB Saunders Company, 1999: 553–607Google Scholar
  9. 9.
    Fedson DS. The clinical effectiveness of pneumococcal vaccination: a brief review. Vaccine 1999; 17Suppl. 1: 85–90CrossRefGoogle Scholar
  10. 10.
    Clemens JD, Shapiro ED. Resolving the pneumococcal vaccine controversy: are there alternatives to randomized clinical trials? Rev Infect Dis 1984; 6: 589–600PubMedCrossRefGoogle Scholar
  11. 11.
    Comstock GW. Evaluating vaccination effectiveness and vaccine efficacy by means of case-control studies. Epidemiol Rev 1994; 16: 77–89PubMedGoogle Scholar
  12. 12.
    Shapiro ED, Clemens JD. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann Intern Med 1984; 101: 325–30PubMedGoogle Scholar
  13. 13.
    Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325: 1453–60PubMedCrossRefGoogle Scholar
  14. 14.
    Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. JAMA 1993; 270: 1826–31PubMedCrossRefGoogle Scholar
  15. 15.
    Hirschmann JV, Lipsky BA. The pneumococcal vaccine after 15 years of use. Arch Intern Med 1994; 154: 373–7PubMedCrossRefGoogle Scholar
  16. 16.
    Hak E, van Essen GA, Grobbee DE, et al. Effectiveness of pneumococcal vaccine [letter]. Lancet 1998; 351: 1283PubMedCrossRefGoogle Scholar
  17. 17.
    Marston BJ, Plouffe JF, File Jr TM, et al. Incidence of community-acquired pneumonia requiring hospitalization. Arch Intern Med 1997; 157: 1709–18PubMedCrossRefGoogle Scholar
  18. 18.
    Smith MD, Stuart J, Andrews NJ, et al. Invasive pneumococcal infection in South and West England. Epidemiol Infect 1998; 120: 117–23PubMedCrossRefGoogle Scholar
  19. 19.
    Fedson DS, Scott JAG. The burden of pneumococcal disease among adults in developed and developing countries: what is and is not known. Vaccine 1999; 17Suppl. 1: 11–8CrossRefGoogle Scholar
  20. 20.
    Sisk JE, Moskowitz AJ, Whang W, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997; 278: 1333–9PubMedCrossRefGoogle Scholar
  21. 21.
    Fedson DS. Pneumococcal vaccination in the prevention of community-acquired pneumonia: an optimistic view of cost-effectiveness. Semin Respir Infect 1993; 8: 285–93PubMedGoogle Scholar
  22. 22.
    Fedson DS, Hirota Y, Shin HK, et al. Influenza vaccination in 22 developed countries: an update to 1995. Vaccine 1997; 15: 1506–11PubMedCrossRefGoogle Scholar
  23. 23.
    Fedson DS. Pneumococcal vaccination in the United States and 20 other developed countries, 1981–1996. Clin Infect Dis 1998; 26: 1117–23PubMedCrossRefGoogle Scholar
  24. 24.
    Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among adults ≥ 65 years — United States, 1997. MMWR 1998; 47: 797–802Google Scholar
  25. 25.
    Fedson DS. The changing use of pneumococcal vaccine in developed countries. Can J Infect Dis 1999; 10Suppl. A: 60A–4Google Scholar
  26. 26.
    Watkins J. Pneumococcal vaccine use by UK doctors [abstract]. First International Symposium on Pneumococci and Pneumococcal Diseases; 1998 Jun 13–17; Elsinore, Denmark: 79Google Scholar
  27. 27.
    Sankilampi U, Honkanen PO, Bloigu A, et al. Persistence of antibodies to pneumococcal capsular polysaccharide vaccine in the elderly. J Infect Dis 1997; 176: 1100–4PubMedCrossRefGoogle Scholar
  28. 28.
    Jackson LA, Benson P, Sneller V-P, et al. Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA 1999; 281: 243–8PubMedCrossRefGoogle Scholar
  29. 29.
    Dagan R, Muallem M, Melamed R, et al. Reduction of pneumococcal nasopharyngeal carriage in early infancy after immunization with tetravalent pneumococcal vaccines conjugated to either tetanus toxoid of diphtheria toxoid. Pediatr Infect Dis J 1997; 16: 1060–4PubMedCrossRefGoogle Scholar
  30. 30.
    Black S, Shinefield H, Ray P, et al. Efficacy of heptavalent conjugate pneumococcal vaccine (Wyeth-Lederle) in 37,000 infants and children: results of the Northern California Kaiser Permanente Efficacy Trial [abstract LB9]. 38th Interscience Conference on Antimicrobial Agents and Chemotherapy; 1998 Sep 24–27: San DiegoGoogle Scholar
  31. 31.
    Powers DC, Anderson EL, Lottenbach K, et al. Reactogenicity and immunogenicity of a protein-conjugated pneumococcal oligosaccharide vaccine in older adults. J Infect Dis 1996; 173: 1014–8PubMedCrossRefGoogle Scholar
  32. 32.
    Chan CY, Molrine DC, George S, et al. Pneumococcal conjugate vaccine primes for antibody responses to polysaccharide pneumococcal vaccine after treatment of Hodgkin’s disease. J Infect Dis 1996; 173: 256–8PubMedCrossRefGoogle Scholar
  33. 33.
    Vernacchio L, Neufeld EJ, MacDonald K, et al. Combined schedule of 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal vaccine in children and young adults with sickle cell disease. J Pediatr 1998; 133: 275–8PubMedCrossRefGoogle Scholar
  34. 34.
    Antilla M, Eskola J, Käyhty H. Opsonic activity and concentration of antibodies to Streptococcus pneumoniae type 6B polysaccharide [abstract]. 35th Annual Meeting of the Infectious Diseases Society of America; 1997 Sep 13–16; San Francisco: 183Google Scholar
  35. 35.
    Vidarsson G, Sigurdardottir ST, Gudnason T, et al. Isotypes and opsonophagocytosis of pneumococcus type 6B antibodies elicited in infants and adults by an experimental pneumococcus type 6B-tetanus toxoid vaccine. Infect Immun 1998; 66: 2866–70PubMedGoogle Scholar
  36. 36.
    Fedson DS, Henrichsen J, Mäkelä PH, et al. Immunization of elderly people with polyvalent pneumococcal vaccine. Infection 1989; 17: 437–41PubMedCrossRefGoogle Scholar
  37. 37.
    Riley ID, Tarr PI, Andrews M, et al. Immunisation with a polyvalent pneumococcal vaccine. Reduction of adult respiratory mortality in a New Guinea Highlands community. Lancet 1977; 1: 1338–41PubMedCrossRefGoogle Scholar
  38. 38.
    Kirkwood BR, Gove S, Rogers S, et al. Potential interventions for the prevention of childhood pneumonia in developing countries: a systematic review. Bull World Health Organ 1995; 73: 793–8PubMedGoogle Scholar
  39. 39.
    Mulholland EK. A new research strategy for accelerating development of pneumococcal vaccines. A report prepared for the Scientific Advisory Group of Experts, Global Programme for Vaccines and Immunization. Geneva: World Health Organisation, 1997Google Scholar
  40. 40.
    Hausdorff WP. Prospects for the use of new vaccines in developing countries: cost is not the only impediment. Vaccine 1996; 14: 1179–86PubMedCrossRefGoogle Scholar
  41. 41.
    Briles DE, Tart RC, Swiatlo E, et al. Pneumococcal diversity: considerations for new vaccine strategies with emphasis on pneumococcal surface protein A (PspA). Clin Microbiol Rev 1998; 11: 645–57PubMedGoogle Scholar
  42. 42.
    Paton JC. Novel pneumococcal surface proteins: role in virulence and vaccine potential. Trends Microbiol 1998; 6: 85–7PubMedCrossRefGoogle Scholar
  43. 43.
    French N, Nakiyingi J, Carpenter L, et al. Lack of efficacy of 23-valent pneumococcal polysaccharide vaccine in HIV-Iinfected Ugandan adults [abstract]. In: Pneumococcal vaccines for the world 1998; Washington DC, 1998Google Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.Pasteur-Mérieux MSDLyon Cedex 07France

Personalised recommendations