Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine Against Invasive Disease and Hospital-Treated Pneumonia Among People Aged ≥65 Years: A Retrospective Case-Control Study

Leventer‐Roberts, Maya; Feldman, Becca; Brufman, Ilan; Cohen-Stavi, Chandra; Hoshen, Moshe; Balicer, Ran D.

doi:10.1093/cid/civ096

Cited by 56 publications

(50 citation statements)

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“…However, despite the low carriage rates in the elderly (8,40), Streptococcus pneumoniae is the most common cause of pneumonia in this cohort (41)(42)(43). Furthermore, vaccination of older adults does not reduce pneumonia and leads to only a trivial reduction in invasive pneumococcal disease (44,45). Since S. pneumoniae colonization is influenced by the composition of the nasopharyngeal microbiome, we hypothesized that age-related microbial dysbiosis influences the kinetics of pneumococcal colonization.…”

Section: Discussionmentioning

confidence: 98%

Streptococcus pneumoniae Colonization Disrupts the Microbial Community within the Upper Respiratory Tract of Aging Mice

et al. 2016

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f Nasopharyngeal colonization by the Gram-positive bacterium Streptococcus pneumoniae is a prerequisite for pneumonia and invasive pneumococcal diseases. Colonization is asymptomatic, involving dynamic and complex interplay between commensals, the host immune system, and environmental factors. The elderly are at an increased risk of developing pneumonia, which might be due to changes in the respiratory microbiota that would impact bacterial colonization and persistence within this niche. We hypothesized that the composition of the upper respiratory tract (URT) microbiota changes with age and subsequently can contribute to sustained colonization and inefficient clearance of S. pneumoniae. To test this, we used a mouse model of pneumococcal colonization to compare the composition of the URT microbiota in young, middle-aged, and old mice in the naive state and during the course of colonization using nasal pharyngeal washes. Sequencing of variable region 3 (V3) of the 16S rRNA gene was used to identify changes occurring with age and throughout the course of S. pneumoniae colonization. We discovered that age affects the composition of the URT microbiota and that colonization with S. pneumoniae is more disruptive of preexisting communities in older mice. We have further shown that host-pathogen interactions following S. pneumoniae colonization can impact the populations of resident microbes, including Staphylococcus and Haemophilus. Together, our findings indicate alterations to the URT microbiota could be detrimental to the elderly, resulting in increased colonization of S. pneumoniae and decreased efficiency in its clearance.

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Section: Discussionmentioning

confidence: 98%

Streptococcus pneumoniae Colonization Disrupts the Microbial Community within the Upper Respiratory Tract of Aging Mice

et al. 2016

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“…More longitudinal data are needed for further assessment of PCV13. The efficacy and effectiveness of PPV23, which differs from conjugated vaccines, are relatively lower (24)(25)(26), and the protection of PPV23 appears to wane after 5 years (27). It is not surprising to see cases in individuals who had been immunized.…”

Section: Discussionmentioning

confidence: 99%

Invasive bacterial diseases in Northern Canada, 2006–2013

Ya¹,

Martín²,

Tsang³

et al. 2016

CCDR

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“…6b) was 59 %; this figure falls between the results of the RCTs and the cohort studies. Effectiveness was lower in the most recent study, conducted by Leventer-Roberts et al [48]. That may be because the percentage of IPD cases caused by serotypes contained in PPSV23 had al- Table 3 of the publication for the combined group of ≥65-year-olds vaccinated in the past 0-<2 or 2-<5 years, excluding the immunocompromised group Tätigkeitsberichte ready dropped because of infant vaccination with PCV7 when the study was conducted in 2008-2010.…”

Section: Ppsv23mentioning

confidence: 93%

“…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%

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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Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine Against Invasive Disease and Hospital-Treated Pneumonia Among People Aged ≥65 Years: A Retrospective Case-Control Study

Abstract: The PPSV23 vaccine is effective against the most severe invasive forms of pneumococcal disease, but the lack of effectiveness of PPSV23 in protecting against all-cause HTP should be considered for future vaccine policies.

Cited by 56 publications

References 30 publications

Streptococcus pneumoniae Colonization Disrupts the Microbial Community within the Upper Respiratory Tract of Aging Mice

Streptococcus pneumoniae Colonization Disrupts the Microbial Community within the Upper Respiratory Tract of Aging Mice

Invasive bacterial diseases in Northern Canada, 2006–2013

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

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