Publications from searches over all available years in Medline and PubMed databases were used as source material for this update. Relevant papers were considered for inclusion irrespective of primary language if an English translation of the title and abstract was provided. Search terms were “pneumococcal vaccines”, “pneumococcal infections—prevention and control”, and “pneumococcal infections—epidemiology”. Several other sources were obtained from hand searches of references in reviews in
ReviewEfficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence
Section snippets
Vaccine efficacy against pneumococcal pneumonia in populations with high attack rates
Previously reported estimates of the effect of vaccines have been converted here to vaccine efficacy (1 minus the relative risk of events in vaccinated compared with unvaccinated individuals). Protection against pneumococcal pneumonia of 60–80% was noted in randomised controlled trials of a 6–12-valent polysaccharide vaccine in young healthy South African gold-miners and in Papua New Guinea highlanders in the 1970s.6, 9, 10 In Papua New Guinea, efficacy against all radiological pneumonia was
Efficacy of the current polysaccharide pneumococcal vaccine against pneumococcal pneumonia in more developed countries
The two main outcome measures in the vaccine trials discussed here are pneumococcal pneumonia and pneumococcal bacteraemia. However, there is no standard definition of pneumococcal pneumonia. Because the sensitivity of culture is very low, the trial sample size required would be prohibitively large if culture of S pneumoniae from a normally sterile site was required for diagnosis of pneumococcal pneumonia; other, imperfect, correlates have therefore been used. The most commonly used definition
Primary trials and meta-analyses
There is consistent, though not significant, evidence that the incidence of bacteraemia is reduced with the polysaccharide vaccine in populations in more developed countries, but the primary trials were not designed to be powered for this outcome.34 In the trial of 600 patients discharged with pneumonia,27 five cases of bacteraemic disease occurred in the placebo group and one in the vaccine group. There was no difference in mortality. The study was included in a small meta-analysis by Moore
Efficacy of the polysaccharide vaccine against mortality
Although there is some evidence from trials, supported by most observational studies, that the vaccine may reduce the incidence of pneumococcal bacteraemia, there is no evidence as yet that death is prevented in more developed countries.
Two meta-analyses tried to summarise the effect of the vaccine against death from pneumonia (table 3).23, 24 None of the deaths in the trials included were in patients diagnosed as having pneumococcal bacteraemia. The point estimate of the vaccine efficacy
Summary of the evidence
The 23-valent polysaccharide pneumococcal vaccine has been recommended for elderly people in more developed countries because they are at higher risk of pneumococcal disease than the general population and the vaccine is considered a cost-effective intervention against bacteraemia.
In the USA, pneumococcal vaccination of people aged 65 years and older was estimated to be cost-saving,4 with the assumption that hospital-admission costs associated with bacteraemia were saved, and that vaccine
Further issues
Other outstanding issues with the current pneumococcal polysaccharide vaccine are the basis for recommending booster doses and rates of adverse events.
Search strategy and selection criteria
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Cited by (112)
Pneumococcal pep27 mutant immunization stimulates cytokine secretion and confers long-term immunity with a wide range of protection, including against non-typeable strains
2016, VaccineCitation Excerpt :S. pneumoniae contributes considerably to high morbidity and mortality due to bacterial respiratory tract infection and invasive disease worldwide [37]. The development of polysaccharide-based vaccines was a major advance in protection against invasive pneumococcal diseases [38,39]. However, limitations such as lack of T cell help [40] and serotype-specific protection [41] lead to great interest in the development of serotype-independent pneumococcal vaccines.
Hajj vaccinations—facts, challenges, and hope
2016, International Journal of Infectious DiseasesCitation Excerpt :PCV13 is approved for use in children aged 6 weeks and over and ACIP recommends its use in all children aged 2 months and over.40–42 Although PPV23 is not highly immunogenic in children,43–45 it does confer short-lived protection in adults by preventing invasive disease.46–53 Multiple studies have shown that the pneumococcal conjugate vaccines are more effective than the polysaccharide vaccine in preventing invasive and non-invasive infections in children less than 5 years old54–57 and adults (>65 years old)58,59 and for preventing pneumococcal disease in immunocompromised patients.60,61
Evolution over a 15-year period of the clinical characteristics and outcomes of critically ill patients with severe community-acquired pneumonia
2016, Medicina IntensivaCitation Excerpt :A plausible explanation for these findings could be the widespread use of pneumococcal vaccination in general and the introduction of the 23-valent vaccine in particular. This vaccine protects against invasive pneumococcal disease, but not against less invasive infections that do not cause bacteremia as it has been suggested elsewhere.22 A study in patients older than 65 years published in 200323 found that the 23-valent vaccine was effective against invasive pneumococcal disease in immunocompetent patients, but did not decrease the risk of developing any type of pneumococcal pneumonia.
Pneumococcal infections: Appraisal and perspectives in terms of adult vaccination
2015, Presse Medicale