Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk – A Systematic Review and Meta-Analysis

Schiffner-Rohe, J.; Witt, A; Hemmerling, Jana; Eiff, Christof von; Leverkus, Friedhelm

doi:10.1371/journal.pone.0146338

Cited by 71 publications

(54 citation statements)

References 27 publications

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“…The protective effect of vaccination should be better assessed in randomized clinical trials. The results of this systematic review agree with those of a meta-analysis of the efficacy of pneumococcal vaccination in adults, which also concluded that vaccination does not appear to be effective in preventing pneumonia [41,42] . However, meta-analyses have produced conflicting results for the efficacy of 23-valent pneumococcal polysaccharide vaccine [43,44] .…”

Section: Discussionsupporting

confidence: 82%

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Almirall

Serra‐Prat²,

Bolíbar³

et al. 2017

Respiration

185

151

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We performed a systematic review of the literature to establish conclusive evidence of risk factors for community-acquired pneumonia (CAP). Observational studies (cross-sectional, case-control, and cohort studies) the primary outcome of which was to assess risk factors for CAP in both hospitalized and ambulatory adult patients with radiologically confirmed pneumonia were selected. The Newcastle-Ottawa Scale specific for cohort and case-control designs was used for quality assessment. Twenty-nine studies (20 case-control, 8 cohort, and 1 cross-sectional) were selected, with 44.8% of them focused on elderly subjects ≥65 years of age and 34.5% on mixed populations (participants' age >14 years). The median quality score was 7.44 (range 5-9). Age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease, asthma, functional impairment, poor dental health, immunosuppressive therapy, oral steroids, and treatment with gastric acid-suppressive drugs were definitive risk factors for CAP. Some of these factors are modifiable. Regarding other factors (e.g., gender, overweight, alcohol use, recent respiratory tract infections, pneumococcal and influenza vaccination, inhalation therapy, swallowing disorders, renal and liver dysfunction, diabetes, and cancer) no definitive conclusion could be established. Prompt assessment and correction of modifiable risk factors could reduce morbidity and mortality among adult CAP patients, particularly among the elderly.

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Section: Discussionsupporting

confidence: 82%

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Almirall

Serra‐Prat²,

Bolíbar³

et al. 2017

Respiration

185

151

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“…After completion of our meta-analysis, two further meta-analyses of the efficacy of PPSV23 in older adults were published in 2016 [67,68]. (a) The meta-analysis by Schiffner-Rohe [67] was commissioned by Pfizer and all authors were employees of the company or a consulting firm working for it. Because Pfizer is the manufacturer of the competing product PCV13, the authors have a strong conflict of interest.…”

Section: Ppsv23mentioning

confidence: 99%

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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“…The Advisory Committee on Immunization Practices in the United States recommends combination strategies using PCV13 and PPV23 for adults aged 65 or older (37), whereas the Japanese Ministry of Health, Labour and Welfare recommends using only PPV23 as a routine vaccination for the elderly. According to recent meta-analyses, the effectiveness of PPV23 against IPD was 50-54 (38), but there is still controversy about its preventive effects against pneumococcal pneumonia (39). In our study, there was a significant increase in the total proportion of serotypes of PPV23-PCV13, which may have the same trend even after the replacement of PCV7 by PCV13 for children.…”

Section: Discussionmentioning

confidence: 44%

Serotype Replacement in Adult Pneumococcal Pneumonia after the Introduction of Seven-Valent Pneumococcal Conjugate Vaccines for Children in Japan: a Systematic Literature Review and Pooled Data Analysis

et al. 2017

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Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk – A Systematic Review and Meta-Analysis

Cited by 71 publications

References 27 publications

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

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

Serotype Replacement in Adult Pneumococcal Pneumonia after the Introduction of Seven-Valent Pneumococcal Conjugate Vaccines for Children in Japan: a Systematic Literature Review and Pooled Data Analysis

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