Lack of effectiveness of the 23-valent polysaccharide pneumococcal vaccine in reducing all-cause pneumonias among healthy young military recruits: A randomized, double-blind, placebo-controlled trial

Russell, Kevin L.; Baker, Carolyn I; Hansen, Christian J.; Ryan, Margaret A. K.; Merrill, Mary M.; Gray, Gregory C.

doi:10.1016/j.vaccine.2014.12.058

Cited by 15 publications

(13 citation statements)

References 29 publications

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“…The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is included in the Australian national immunisation programme for adults aged 65 years and over for protection against IPD, but protection wanes by 5 years after vaccination [26]. Although effective against IPD, a recent large-scale study of PPSV23 vaccination in more than 152,000 healthy adults clearly demonstrated no vaccine effect on pneumonia incidence [27]. These findings were confirmed in another study that showed vaccination was associated with a 42 % reduction in risk of IPD, but had no effect on pneumonia hospitalisation rates [28].…”

Section: Discussionmentioning

confidence: 99%

Burden of pneumococcal disease in adults aged 65 years and older: an Australian perspective

Earle

Williams

2016

pneumonia

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BackgroundThe burden of pneumococcal disease in adults aged 65 years and older in Australia is not well defined. This retrospective cross-sectional study calculated rates for pneumococcal pneumonia using data from the Australian Institute of Health and Welfare and from the Bettering Evaluation and Care of Health program.MethodsInvasive pneumococcal disease (IPD) incidence was calculated using National Notifiable Diseases Surveillance System data. Population estimates and pneumonia mortality data were from the Australian Bureau of Statistics. Medical costs were derived from Australian Refined Diagnosis Related Groups and the literature. Clinical and economic burden of pneumococcal pneumonia hospitalisations and general practitioner (GP) visits were described and compared with IPD.ResultsFor adults aged ≥65 years, pneumococcal pneumonia hospitalisation incidence was 274 per 100,000 population in 2011–2012. From 2004 to 2012, a mean of 2235 pneumonia hospitalisation deaths were recorded, corresponding to a case fatality rate of 6.1 %. GP visits accounted for the largest portion of healthcare encounters, with an annual average of 455 pneumococcal pneumonia GP visits per 100,000 population from 2008 to 2013. In 2012, IPD incidence was 19 per 100,000 population. The estimated annual costs of treating pneumococcal pneumonia hospitalisations and GP visits were A$55,722,136 and A$1,604,189, respectively. Estimated costs for IPD were A$1,172,986.ConclusionsThe healthcare and economic burden of pneumococcal disease in adults aged ≥65 years in Australia is substantial, with the incidence of pneumococcal pneumonia hospitalisation nearly 15-fold higher than for IPD. Despite this, it remains less recognised than other infectious diseases such as influenza.

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Section: Discussionmentioning

confidence: 99%

Burden of pneumococcal disease in adults aged 65 years and older: an Australian perspective

Earle

Williams

2016

pneumonia

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“…Unfortunately, pneumococcal vaccines have not shown consistent effectiveness in reducing NP carriage rates and subsequent spread to susceptible personnel (471). Moreover, in a large RCT of the 23-valent pneumococcal vaccine among U.S. military recruits, no efficacy was demonstrated in terms of reducing pneumonia during recruit training or for up to 7 years after enrollment (472). Influenza vaccination has been shown to reduce secondary bacterial infections, including pneumococcal infections and pneumonia, and should be routinely administered to personnel at high risk (2,473).…”

Section: Pneumococcus and Influenza: What Is The Connection?mentioning

confidence: 99%

Respiratory Infections in the U.S. Military: Recent Experience and Control

et al. 2015

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SUMMARY This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.

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“…The modelling analysis of changes in outcomes attributable to PCV13 showed statistically significant (p \ 0.05) reductions of 37 % for IPD (95 % CI 20-51), 32 % (95 % CI 17-44) for noninvasive pneumococcal or lobar pneumonia and 12 % (95 % CI 6-17) for all-cause pneumonia among adults aged 18-39 years. There were also significant reductions in hospital admissions for noninvasive pneumococcal or lobar pneumonia in adults aged 40-64 years (by 25 %; 95 % CI [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] and in older adults aged C65 years (by 34 %; 95 % CI 27-41), and for IPD in those aged C65 years (by 29 %; 95 % CI . These findings suggest a strong and rapid development of herd protection.…”

Section: Postmarketing Surveillance Studiesmentioning

confidence: 99%

“…The 23-valent pneumococcal polysaccharide vaccine (PPSV23), which has been available in many countries for about three decades, consists of 23 serotype-specific pneumococcal capsular polysaccharide antigens [1,2]. Although some studies with PPSV23 have demonstrated protection against IPD in adults, its efficacy against noninvasive pneumonia is unclear or lacking [10][11][12][13][14][15][16][17]. There are also concerns about the extent to which the protective effectiveness of PPSV23 varies by age of recipient, time since vaccination and the presence of underlying disease [18].…”

Section: Introductionmentioning

confidence: 99%

13-Valent Pneumococcal Conjugate Vaccine: A Review of Its Use in Adults

Plosker

2015

Drugs

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The 13-valent pneumococcal conjugate vaccine (Prevenar 13(®), Prevnar 13(®)) [PCV13] consists of 13 serotype-specific polysaccharides of Streptococcus pneumoniae (pneumococcus), each covalently conjugated to a non-toxic immunogenic carrier protein. PCV13 has a well established immunogenicity and tolerability profile in adults, particularly those ≥50 years of age. Results of CAPiTA, a randomized, double-blind, placebo-controlled trial in >84,000 older adults aged ≥65 years, showed that PCV13 was effective in preventing vaccine-type pneumococcal community-acquired pneumonia (CAP), vaccine-type pneumococcal nonbacteraemic (noninvasive) CAP and vaccine-type invasive pneumococcal disease (IPD). These findings, along with changes in pneumococcal serotype distribution and epidemiology of pneumococcal disease, prompted the US Advisory Committee on Immunization Practices (ACIP) to recommend PCV13 in series with 23-valent pneumococcal polysaccharide vaccine (PPVS23) for all adults aged ≥65 years. PCV13 also has a role in preventing pneumococcal disease (pneumonia and IPD) in younger adults with immunocompromising conditions and potentially in those with other underlying medical conditions that increase the risk of pneumococcal disease.

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Lack of effectiveness of the 23-valent polysaccharide pneumococcal vaccine in reducing all-cause pneumonias among healthy young military recruits: A randomized, double-blind, placebo-controlled trial

Cited by 15 publications

References 29 publications

Burden of pneumococcal disease in adults aged 65 years and older: an Australian perspective

Burden of pneumococcal disease in adults aged 65 years and older: an Australian perspective

Respiratory Infections in the U.S. Military: Recent Experience and Control

13-Valent Pneumococcal Conjugate Vaccine: A Review of Its Use in Adults

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