A review of the evidence to inform pneumococcal vaccine recommendations for risk groups aged 2 years and older

Abstract

For decades, vaccination with the 23-valent polysaccharide pneumococcal vaccine (PPV23) has been available for risk groups aged ⩾2 years to prevent invasive pneumococcal disease (IPD). Recently, a 13-valent pneumococcal conjugated vaccine (PCV13) has been licensed for use in all age groups. PCV13 may induce better protection than PPV23 because of different immunogenic properties. This called for a revision of vaccine recommendations for risk groups. We therefore reviewed literature on risk groups for IPD, and effectiveness and safety of pneumococcal vaccines and supplemented that with information from public health institutes, expert consultations and data on IPD epidemiology. We included 187 articles. We discuss the implications of the heterogenic vulnerability for IPD within and between risk groups, large indirect effects of childhood immunization, and limited knowledge on additional clinical benefits of PCV13 in combination with PPV23 for the Norwegian recommendations. These are now step-wise and consider the need for vaccination, choice of pneumococcal vaccines, and re-vaccination interval by risk group.

Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV13

“…Childhood vaccination with PCV13 should be continued to keep low PCV13 carriage, transmission and disease. Furthermore, the low prevalence of PCV13-type carriage in children endorses the choice of not recommending PCV13 as main vaccine to medical risk groups in Norway, as little disease caused by PCV13 serotypes can be expected [43].…”

“…The age and sex distributions did not differ between the study years; see Additional file 1: Table S1. In 2015, the carriage prevalence was 38% [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] lower than in 2006 pre-PCV7, and 23% lower than in 2013, 2 years after switching to PCV13 (Fig. 2).…”

Envelope Structures of Gram-Positive Bacteria

“…Today different variations on pneumococcal vaccines are available, incorporating up to 23 polysaccharide variants (PPSV23), or conjugate vaccines incorporating 7 (PCV7) or 13 (PCV13) CPS serotypes (Bogaert et al . 2004; Pilishvili and Bennett 2015; Steens et al . 2014).…”

The ageing human B cell repertoire: a failure of selection?

“…Very young and elderly people have less resistance to Streptococcus pneumoniae , older people being three times more susceptible to pneumonia than young adults and having a greater morbidity and risk of mortality . The 23 valent pneumococcal polysaccharide vaccine is also less efficient at protecting very young and elderly people, although in the case of young people this has been circumvented by conjugating the polysaccharide to a protein antigen . There are many more infections, with perhaps a lower profile, that increase in incidence and morbidity with age ; for example, urinary tract infections are up to ×20 more common in older people .…”