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Pneumococcal Disease in the Elderly

What is Preventing Vaccine Efficacy?

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Abstract

The effective prevention of Streptococcus pneumoniae infection has a renewed priority in an era in which the emergence of antibacterial-resistant strains has the potential to further compromise efforts to reduce early mortality from invasive pneumococcal infection. Although the 23-valent pneumococcal polysaccharide (PPS) vaccine was approved in the US to prevent respiratory and invasive infection in the elderly and other high-risk populations, the protective efficacy of this vaccine for the growing population of adults aged >65 years remains controversial. The apparent effectiveness of pneumococcal immunisation in clinical studies of elderly adults has varied depending upon whether a reduction in pneumococcal colonisation, pneumonia, bacteraemia or death was used as an outcome.

Clinical studies of vaccine efficacy to date suggest that the current pneumococcal vaccine is 56 to 81% effective at preventing invasive pneumococcal infection, and may have additive benefit to influenza vaccine in preventing community-acquired pneumonia, particularly in elderly adults with an increased risk of serious pneumonia requiring hospitalisation. Possible reasons for incomplete protection from pneumococcal infection after immunisation include infection with non-vaccine serotypes, inadequate or ineffective antibody responses, waning of antibody responses, or compromised nonhumoral host defences. Further studies are needed to determine whether: (i) elderly adults who respond poorly to the 23-valent pneumococcal vaccine can be identified prior to immunisation and targeted for study with improved pneumococcal vaccines; (ii) specific nutrient deficiencies can be identified and corrected to improve the immune responsiveness of elderly adults to the PPS vaccine; (iii) newer protein-conjugate or DNA pneumococcal vaccines may be more uniformly immunogenic for elderly adults; and (iv) whether smoking cessation reduces the risk of invasive pneumococcal infection in elderly adults.

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Authors and Affiliations

  1. Pulmonary Diseases, Veterans Affairs Medical Center and Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA

    Jeffrey B. Rubins

  2. Infectious Diseases, Veterans Affairs Medical Center and Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA

    Edward N. Janoff

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  1. Jeffrey B. Rubins
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Correspondence to Jeffrey B. Rubins.

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Rubins, J.B., Janoff, E.N. Pneumococcal Disease in the Elderly. Drugs & Aging 18, 305–311 (2001). https://doi.org/10.2165/00002512-200118050-00001

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