Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales

Andrews, Nick; Waight, Pauline; George, Robert C.; Slack, Mary P. E.; Miller, Elizabeth

doi:10.1016/j.vaccine.2012.09.019

Cited by 209 publications

(185 citation statements)

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“…Andrews et al [21] arrived at similar results in their calculation of PPSV23 effectiveness using the Broome method. For people aged 65-74 years, effectiveness against VT-IPD was 65 % (95 % CI, 23-84 %) within <2 years after vaccination and 62 % (95 % CI, 21-82 %) in the period 2-5 years after vaccination.…”

Section: Duration Of Vaccine Protectionmentioning

confidence: 69%

“…For that reason, we included only studies in which important confounders (at least age and comorbidities) were recorded and taken into account in an adjusted statistical analysis. Three registry-based cohort studies [43,44,46], 3 matched case-control studies [47][48][49], and 4 "case-case studies" using the Broome method [21,[50][51][52] fulfilled this condition. Efficacy against PP was also investigated in a study with a similar case-case design, in which pneumonia cases caused by other pathogens or with no identified pathogen were used as the control group [53].…”

Section: Ppsv23mentioning

confidence: 95%

“…6.2). In an evaluation of British IPD surveillance data according to the Broome method, the efficacy of PPSV23 against IPD caused by ST 3 (along with the much rarer ST 1) in older adults was significantly lower than for the other PPSV23 serotypes investigated [21].…”

Section: Serotype Distribution Since Introduction Of Universal Infantmentioning

confidence: 92%

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Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Falkenhorst

Remschmidt

Harder

et al. 2016

Bundesgesundheitsbl

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are members of the German Standing Committee on Vaccination (STIKO). Bundesgesundheitsblatt -Gesundheitsforschung -Gesundheitsschutz 12 · 2016 1624Tätigkeitsberichte Summary Background and objective The incidence of pneumococcal diseases among adults increases with age. Therefore, Germany's Standing Committee on Vaccination (Ständige Impfkommission, STIKO) has since 1998 recommended vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all people aged ≥60 years. PPSV23 has been the only pneumococcal vaccine licensed for adults until few years ago. Universal pneumococcal vaccination of infants, using a conjugate vaccine, has been recommended by STIKO since 2006. Since then, pneumococcal serotypes contained in conjugate vaccines have declined among cases of pneumococcal disease not only in children, but -through herd protection -also in older adults. The 13-valent pneumococcal conjugate vaccine (PCV13), currently used for most infants in Germany, has now been approved for use in adults as well. Data on the efficacy of PCV13 against clinical endpoints in older adults was published in 2015. For that reason, STIKO investigated whether one of the two vaccines (or the combination of both) should be preferred in order to reduce the burden of pneumococcal diseases in older adults, and at what age the vaccine should be given. Efficacy against invasive pneumococcal diseasesPooled data from 4 randomised controlled trials (RCTs) of PPSV23 in older adults show an efficacy of 73 % against invasive pneumococcal disease (IPD) caused by any serotype (95 % confidence interval [CI], 10-92 %). The IPD cases in these studies were mostly caused by one of the 23 serotypes contained in the vaccine. The efficacy of PCV13 in older adults was investigated in one RCT. Efficacy against IPD by any serotype was 49 % (95 % CI, 21-67 %, modified-intention-to-treat analysis). Efficacy against IPD by the 13 serotypes contained in the vaccine (VT-IPD) was 76 % (95 % CI, 47-90 %). Efficacy against pneumococcal pneumoniaAfter exclusion of 2 RCTs with a high risk of bias, pooled efficacy of PPSV23 against pneumococcal pneumonia (PP) caused by any serotype in the remaining 2 RCTs was 64 % (95 % CI, 35-80 %). In the included observational studies, pooled efficacy ranged from 37 % to 53 %, with broadly overlapping CIs, depending on study type. The efficacy of PCV13 against PP caused by any serotype was 22 % (95 % CI, 2-39 %), and against VT-PP it was 38 % (95 % CI, 14-55 %). Anticipated epidemiological and health economic effectsThe above-mentioned studies do not provide clear evidence of a difference between the two vaccines regarding efficacy against clinical endpoints (IPD, PP) caused by the serotypes contained in the respective vaccine. In the 2015-'16 season, 70 % of IPD cases in people aged ≥60 years were caused by PPSV23 serotypes, but only 30 % by PCV13 serotypes. Because PPSV23 contains all the serotypes in PCV13 (except for serotype 6A), vaccination with PPSV23 confers broader serotype coverage and can thereby prevent ...

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Section: Duration Of Vaccine Protectionmentioning

confidence: 69%

Section: Ppsv23mentioning

confidence: 95%

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Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Falkenhorst

Remschmidt

Harder

et al. 2016

Bundesgesundheitsbl

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“…25 Adults over the age of 65 are the only population to routinely receive PPV-23. This vaccine appears to offer a degree of short-term protection against invasive pneumococcal disease, 35 but no reduction in rates of pneumonia or mortality. 36,37 Furthermore, immunization with plain polysaccharide vaccines may reduce antibody levels induced by prior receipt of a polysaccharide-containing vaccine, an effect known as hyporesponsiveness.…”

Section: -Valent Pneumococcal Polysaccharide Vaccine (Ppv-23)mentioning

confidence: 99%

Polysaccharide-specific B cell responses to vaccination in humans

Mitchell

Kelly

Pollard

et al. 2014

Human Vaccines & Immunotherapeutics

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“…8 PPSV23, a free polysaccharide vaccine which elicits T cell¡independent immune responses, has demonstrated efficacy against IPD, and in some settings, pneumonia; 23 however, the duration of protection of PPSV23 is limited to approximately 2-5 years. 24 The limited duration of protection of PPSV23 is associated with waning antibody concentrations and the T cell¡independent nature of the PPSV23 immune responses, with little or no memory response on natural exposure; revaccination is required. Some studies have observed that immune responses of some PPSV23 serotypes are significantly reduced upon revaccination at a 6-month to 4-year interval, which raises the question of hyporesponsiveness.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine compared to the 23-valent pneumococcal polysaccharide vaccine in elderly Japanese adults

Shiramoto¹,

Hanada

Juergens

et al. 2015

Human Vaccines & Immunotherapeutics

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sive pneumococcal disease; LLOQ, lower limit of quantitation; OPA, opsonophagocytic activity; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccineStreptococcus pneumoniae is a major cause of severe disease worldwide, particularly in the elderly population. Due to increasing life expectancy in Japan and elsewhere, an effective vaccine which offers the possibility of prolonged protection is required. Protein conjugated pneumococcal vaccines, which have the ability to boost immunity (immunologic memory) on natural exposure or revaccination, may meet these requirements. An unconjugated 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been available for decades; however data on protection against pneumonia are inconsistent. For the first time, a randomized, modified double-blind trial comparing the 13-valent pneumococcal conjugate vaccine (PCV13) with PPSV23 was conducted in PPSV23-naive adults 65 years of age in Japan. This study showed that statistically significantly greater functional antibody responses as measured by opsonophagocytic assays 1 month after vaccination were elicited in the PCV13 group (n D 366) compared with the PPSV23 group (n D 367) for 9 of the 12 serotypes in common with both vaccines and for serotype 6A, unique to PCV13. Local reactions collected within 14 days of vaccination were more frequent in the PCV13 (57.5%, 211/367) than PPSV23 (44.9%, 166/370) group, although severity was generally mild to moderate; systemic and adverse events were similar across groups. There were no treatment-related serious adverse events. Consistent with global studies comparing PCV13 with PPSV23, PCV13 use in Japanese subjects was safe and well-tolerated and elicited greater functional immune responses than PPSV23 for the majority of PCV13-serotypes. PCV13 has the potential to protect against pneumococcal disease in Japanese elderly adults.

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Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales

Cited by 209 publications

References 20 publications

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

Polysaccharide-specific B cell responses to vaccination in humans

Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine compared to the 23-valent pneumococcal polysaccharide vaccine in elderly Japanese adults

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