Adult vaccination for pneumococcal disease: a comparison of the national guidelines in Europe

Abstract

Background: Pneumococcal disease constitutes a major global health problem. Adults aged over 50 and younger adults with specific chronic health conditions are at risk for invasive pneumococcal disease, associated with substantial morbidity and mortality. In Europe, two vaccine types are used in adults for pneumococcal immunization: pneumococcal polysaccharide vaccine (PPV23) and pneumococcal conjugate vaccine (PCV13). Aims:To provide an overview and to compare the national guidelines for pneumococcal immunization for adults in Europe. Sources:In November 2016, national guidelines on pneumococcal vaccination for adults of 31 European countries were obtained by Google search, the website of European Centre for Disease Prevention and Control and contacting public health officials. In our analysis we distinguished between age-based and risk-based guidelines. In October 2017, we used the same method to retrieve guideline updates. Content:We observed great variability regarding age, risk groups, vaccine type and use of boosters. In age-based guidelines, vaccination is mostly recommended in adults aged over 65 using PPV23. Boosters are generally not recommended. An upper age limit for vaccination is reported in three countries. In the immunocompromised population, vaccination with both vaccines and administration of a booster is mostly recommended. In the population with chronic health conditions, there is more heterogeneity according vaccine type, sequence and administration of boosters. Asplenia is the only comorbidity for which all countries recommend vaccination. Implications: The great variability in European pneumococcal vaccination guidelines warrantsEuropean unification of the guidelines for better control of pneumococcal disease.

Use of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality

“…In countries with an infant PCV program, about 48-66% of invasive pneumococcal disease (IPD) in older adults is caused by serotypes that PPV23 is effective against [26]; in countries without an infant PCV programme this percentage is likely about 20% higher (details see Appendix). PPV23 is recommended for routine use in older adults in most high-income countries, but rarely in low and middle-income countries [27]. It provides short-term protection against IPD caused by vaccine serotypes in healthy older adults with a pooled efficacy across targeted serotypes of about 60% [28][29][30].…”

SLy2‐deficiency promotes B‐1 cell immunity and triggers enhanced production of IgM and IgG2 antibodies against pneumococcal vaccine

“…P23 is a pure mixture of 23 pPS serotypes, triggering TI immune responses and leading to the rapid production of IgM. 17 We immunized SLy2-Wt and Ko littermates with 1 µg P23 and measured serum IgM levels at 4, 7, 14, and 21 days postimmunization (see vaccination timeline in Figure 3A). Figure 3B illustrates the amount of P23specific IgM over time and normalized to day 0 (the fold of control).…”

“…[29][30][31] Beyond its substantial contribution to child mortality, S. pneumoniae also represents a significant health problem in the elderly and immune-deficient patients. 17,30,32 By secretion of toxic mediators, S. pneumoniae efficiently induces host inflammation and evades the immune system through a variety of mechanisms. 16 The outer pPS capsule is the most immunogenic structure of Pneumococci and nowadays, more than 90 different serotypes are known.…”

“…The risk of developing the invasive pneumococcal disease (IPD) is especially given in infants, the elderly and immunedeficient subjects such as patients with DS. 16,17 DS goes ahead with significantly reduced levels of serum IgM and high susceptibility towards infections. A Swedish study identified infectious pneumonia as a leading cause of death in patients with DS.…”

Vaccine strategies to reduce the burden of pneumococcal disease in HIV-infected adults in Africa.

“…Since the 1980s, the 23-valent pneumococcal polysaccharide vaccine (PPV23) has been approved for use in HIV-infected adults for direct protection against a wide range of serotypes, in most high-income countries where it is reported to be safe, including in HIVinfected but otherwise healthy adults [51][52][53][54]. However, evidence of PPV23's efficacy in HIV-infected adults is somewhat controversial [53,[55][56][57][58][59][60], with the suggestion of potential hyporesponsiveness in individuals with advanced immunosuppression, and a reported increase, albeit not statistically significant, in the incidence of allcause pneumonia when given to HIV-infected Ugandan adults, not on ART [61].…”