The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials

Conaty, Stephen; Watson, Lorna; Dinnes, Jacqueline; Waugh, Norman

doi:10.1016/j.vaccine.2003.08.050

Cited by 104 publications

(66 citation statements)

References 44 publications

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“…Meta-analyses of five randomized clinical trials have shown that PPV23 is 68% (95% CI 53-78) effective against IPD among immunocompetent older adults. 49 In our analyses, the values for vaccine effectiveness against were based on multiple observational studies which had the advantage of being conducted in large unselected natural populations 11,37,[50][51][52][53][54][55] (Table 3). One of these recent studies, conducted in Scotland in persons aged ≥65 years, demonstrated a protective effect of PPV23 against IPD of 61.7% (95% CI, 45.1-73.2).…”

Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 99%

“…49,57 However, the results of a recent clinical trial conducted in nursing home residents considered at high risk for CAP (mean age: 85 years) showed that PPV23 reduced pneumococcal pneumonia by 64% (95% CI, 32-81) and all-cause pneumonia by 45% (95% CI, . 58 A systematic review of observational studies, 52 which may be considered to be better estimates of real-life vaccine effectiveness reported an effectiveness of 32% against all pneumonia. In addition, two recent cohort studies conducted in Spain, in which bacteria were identified by radiography, sputum culture, and Binex antigen test, demonstrated an effectiveness against NBPP of 42% (95% CI, 14-61) in persons >50 years old, and 39% (95% CI, -6-65) in elderly >65 irrespective of risk status.…”

Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 99%

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Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

et al. 2011

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Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 99%

Section: ©2 0 1 1 L a N D E S B I O S C I E N C E D O N O T D I S Tmentioning

confidence: 99%

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

et al. 2011

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“…36 Most earlier randomized studies of vaccination with either free polysaccharide vaccines in older adults 37 or pneumococcal conjugate vaccines in HIV-infected adults 21 were underpowered to show efficacy against vaccinetype community-acquired pneumonia; results of these studies and other observational studies have been inconsistent. [11][12][13][14] Our study had several limitations. The study was performed in a single country in a homogeneous population of participants among whom there was a low incidence of pneumococcal disease.…”

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confidence: 95%

Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults

et al. 2015

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BACKGROUNDPneumococcal polysaccharide conjugate vaccines prevent pneumococcal disease in infants, but their efficacy against pneumococcal community-acquired pneumonia in adults 65 years of age or older is unknown. METHODSIn a randomized, double-blind, placebo-controlled trial involving 84,496 adults 65 years of age or older, we evaluated the efficacy of 13-valent polysaccharide conjugate vaccine (PCV13) in preventing first episodes of vaccine-type strains of pneumococcal community-acquired pneumonia, nonbacteremic and noninvasive pneumococcal community-acquired pneumonia, and invasive pneumococcal disease. Standard laboratory methods and a serotype-specific urinary antigen detection assay were used to identify community-acquired pneumonia and invasive pneumococcal disease. RESULTSIn the per-protocol analysis of first episodes of infections due to vaccine-type strains, community-acquired pneumonia occurred in 49 persons in the PCV13 group and 90 persons in the placebo group (vaccine efficacy, 45.6%; 95.2% confidence interval [CI], 21.8 to 62.5), nonbacteremic and noninvasive community-acquired pneumonia occurred in 33 persons in the PCV13 group and 60 persons in the placebo group (vaccine efficacy, 45.0%; 95.2% CI, 14.2 to 65.3), and invasive pneumococcal disease occurred in 7 persons in the PCV13 group and 28 persons in the placebo group (vaccine efficacy, 75.0%; 95% CI, 41.4 to 90.8). Efficacy persisted throughout the trial (mean follow-up, 3.97 years). In the modified intention-totreat analysis, similar efficacy was observed (vaccine efficacy, 37.7%, 41.1%, and 75.8%, respectively), and community-acquired pneumonia occurred in 747 persons in the PCV13 group and 787 persons in placebo group (vaccine efficacy, 5.1%; 95% CI, −5.1 to 14.2). Numbers of serious adverse events and deaths were similar in the two groups, but there were more local reactions in the PCV13 group. CONCLUSIONSAmong older adults, PCV13 was effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccinetype invasive pneumococcal disease but not in preventing community-acquired pneumonia from any cause. (Funded by Pfizer; CAPITA ClinicalTrials.gov number NCT00744263.)

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“…The review by Conaty et al found the vaccine efficacy against IPD to be an estimated 53% (95% CI 46-59%). 22 Singleton et al found 100% (95% CI 78-100%) vaccine efficacy against IPD in the 20-39 y age group and 73% (95% CI < 0-96%) in the 40-54 y age group. 25 Hechter et al did not find a significant level of protection against pneumococcal bacteraemia, but did find significant levels of protection against hospitalisation for all-cause pneumonia (hazard ratio 1.18; 95% CI 1.02-1.37; p D 0.03) in the population overall and in patients without chronic obstructive pulmonary disease (COPD; hazard ratio 1.21; 95% CI 1.02-1.43; p D 0.03) but not in patients with COPD.…”

Section: Pneumococcal Vaccinationmentioning

confidence: 98%

“…A review by Conaty et al included 13 observational studies on PPV. 22 Moreover, PPV23 has also been assessed in 3 further studies. [23][24][25] In recent years, the age indication for PCV13 was first extended from subjects aged 5 y to include those aged 50 y, and subsequently further extended to include all ages based on comparative immunogenicity data, including also the 18-64 y age group.…”

Section: Pneumococcal Vaccinationmentioning

confidence: 99%

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

Esposito

Bonanni

Maggi

et al. 2016

Human Vaccines & Immunotherapeutics

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Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research.

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The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials

Cited by 104 publications

References 44 publications

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

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