Volume 201 - Issue 4
Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older
Author: Peter J Collignon
Med J Aust 2014; 201 (4): 199-200. || doi: 10.5694/mja14.00272
Published online: 18 August 2014
Published online: 18 August 2014
Often recommended, but do they work?
To the Editor: Menzies and colleagues promote the 23-valent polysaccharide pneumococcal vaccine (23vPPV) as effective in people aged 65 years or older.1 I believe their data show exactly the opposite. The vaccine appears to be ineffective.
In 2005, a nationally funded vaccination program began with 23vPPV for those aged ≥ 65 years and a 7-valent pneumococcal conjugate vaccine (7vPCV) for children. Subsequently, there was a rapid and dramatic drop in invasive pneumococcal disease in older people, but this was only for disease due to serotypes covered by the childhood 7vPCV. When the effects of the other components of the 23vPPV are examined, there is no fall but instead a statistically significant increase in invasive infections in older people.1
Vaccinating children with highly effective conjugated pneumococcal vaccines is associated with a dramatic decrease in invasive pneumococcal disease not only in children but also in older people. Older people benefit because vaccinated children carry fewer pneumococcal strains and thus pass on fewer invasive strains to parents and grandparents.2-4
I think that the only reasonable conclusion from the study by Menzies et al is that the non-conjugated vaccine is ineffective in those aged ≥ 65 years. Its use may perversely have even been associated with an increase in invasive disease.
This clearly shows the superiority and easily measured benefits of conjugated pneumococcal vaccines. Why persevere with the unconjugated 23vPPV in older people given its poor or potentially non-existent efficacy? We need to ensure that we have effective pneumococcal vaccines available for older people. This means conjugated pneumococcal vaccines.
Competing interests
No relevant disclosures.
References
- Menzies RI, Jayasinghe SH, Krause VL, et al. Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older. Med J Aust 2014; 200: 112-115. 1
- Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein–polysaccharide conjugate vaccine. N Engl J Med 2003; 348: 1737-1746. 2
- Centers for Disease Control and Prevention. Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease — United States, 1998–2003. MMWR Morb Mortal Wkly Rep 2005; 54: 893-897. 3
- Kyaw MH, Lynfield R, Schaffner W, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 2006; 354: 1455-1463. lefthere