Theory and strategy for Pneumococcal vaccines in the elderly

Abstract

Pneumonia is the fourth-leading cause of death globally, and Streptococcus pneumoniae is the most important causative pathogen. Because the incidence of pneumococcal diseases is likely to increase with the aging society, we should determine an optimal strategy for pneumococcal vaccination. While consensus indicates that 23-valent pneumococcal polysaccharide vaccine prevents invasive pneumococcal diseases (IPD), its effects on community-acquired pneumonia (CAP) remain controversial. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was released. The latest clinical study (CAPiTA study) showed that PCV13 reduced vaccine-type CAP and IPD. Based on these results, the Advisory Committee on Immunization Practices recommended initial vaccination with PCV13 for the elderly. Scientific evidence regarding immunosenescence is needed to determine a more ideal vaccination strategy for the elderly with impaired innate and adaptive immunity. Continuing research on the cost effectiveness of new vaccine strategies considering constantly changing epidemiology is also warranted.

Invasive pneumococcal disease caused by mucoid serotype 3 Streptococcus pneumoniae: a case report and literature review

“…This 2-step vaccination approach is intended to maximize the efficacy of pneumococcal vaccination. Initial PCV13 induces acquired T cell memory function, and wider serotype coverage is induced by the subsequent PPSV23 [16]. In Japan, both PPSV23 and PCV13 have been used in the elderly to prevent pneumococcal infections since the approval of extended use of PCV13 in June 2014.…”

“…For example, many azithromycin-resistant pneumococcal pneumonia cases have successfully been treated using azithromycin alone [18]. A case of severe community-acquired pneumonia due to mucoid S. pneumoniae , that was macrolide-resistant and penicillin-susceptible, was also cured by additional azithromycin administration [16]. Based on the antibiotic susceptibility pattern of S. pneumoniae , penicillins are the first treatment choices for infections caused by serotype 3 strains.…”

Pneumococcal Vaccination in Adults

“…Each vaccine has its own set of bene ts and limitations. See Table 2 3,4 . What is now known is the current pneumococcal vaccination strategy with PPSV23 alone has not been as successful as desired in the adult population.…”

“…Pneumonia in Singapore moved up from being third to second-leading cause of death in Singapore in 2012 1,2 . In Japan, where more than 21% of its population are aged 65 years or older, 95% of deaths from pneumonia occur in this age group 3 while in developing countries, almost two million children a year die from pneumonia 4 . S. pneumoniae is an important pathogen in community acquired pneumonia (CAP) in both older individuals in developed countries and in children in both developed and developing countries.…”

What do we know about the cost-effectiveness of pneumococcal conjugate vaccination in older adults?

“…1 The cost-effectiveness of PCV13 use in older adults and the relative merits of PCV13 when compared to the 23-type pneumococcal polysaccharide vaccine (PPV23) has been a topic of much debate. [2][3][4][5][6][7][8][9][10][11] The costs and benefits of pneumococcal vaccination in adults are likely to rest on several critical parameters: the magnitude pneumococcal disease in older adults and the serotypes responsible for it, the efficacy of each vaccine against invasive and non-invasive pneumonia, the duration of vaccine protection, and differences in vaccine price.…”