Pneumococcal Vaccination in High-Risk Individuals: Are We Doing It Right?

ABSTRACTControversy exists regarding the optimal use of the 23-valent pneumococcal conjugate vaccine for the protection of high-risk individuals, such as children and adults with immunocompromising conditions and the elderly. The effectiveness and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) are limited in such high-risk populations compared to the healthy, with meta-analyses failing to provide robust evidence on vaccine efficacy against invasive pneumococcal disease (IPD) or pneumonia. Moreover, several studies have demonstrated a PPV23-induced state of immune tolerance or hyporesponsiveness to subsequent vaccination, where the response to revaccination does not reach the levels achieved with primary vaccination. The clinical significance of hyporesponsiveness is not yet clarified, but attenuated humoral and cellular response could lead to reduced levels of protection and increased susceptibility to pneumococcal disease. As disease epidemiology among high-risk groups shows that we are still in need of maximum serotype coverage, the optimal use of PPV23 in the context of combined conjugate/polysaccharide vaccine schedules is an important priority. In this minireview, we discuss PPV23-induced hyporesponsiveness and its implications in designing highly effective vaccination schedules for the optimal protection for high-risk individuals.

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Application of the screening and indirect cohort methods to evaluate the effectiveness of pneumococcal vaccination program in adults 75 years and older in Taiwan

BMC Infectious Diseases ◽

10.1186/s12879-020-05721-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei-Ju Su ◽

Pei-Hung Chuang ◽

Luan-Yin Chang ◽

Hsiu-Yun Lo ◽

Chuen-Sheue Chiang ◽

...

Keyword(s):

Relative Risk ◽

Indirect Effects ◽

Pneumococcal Disease ◽

Screening Method ◽

Pneumococcal Vaccination ◽

The Elderly ◽

Polysaccharide Vaccine ◽

Pneumococcal Polysaccharide Vaccine ◽

Direct Effects ◽

Indirect Protection

Abstract Background The Taiwanese national 23-valent pneumococcal polysaccharide vaccine (PPV23) program in adults ≥75 years of age and the 13-valent pneumococcal conjugate vaccine (PCV13) program for children were implemented in 2008 and 2013, respectively. In this study we evaluated PPV23 vaccine effectiveness (PPV23VE) in the elderly, with regard to both direct protection from the vaccine itself and the indirect protection conferred by PCV13 immunization in children. Methods The incidence of invasive pneumococcal disease (IPD) in Taiwan from July 2008 to June 2016 was collected from IPD surveillance data. A comparison of IPD incidence with a nationwide vaccination registry allowed an estimation of PPV23VE by the screening and indirect cohort methods. Results The incidence of IPD in adults ≥75 years of age ranged from 13.9 per 100,000 inhabitants during the period July 2008–June 2013 to 10.4 per 100,000 inhabitants between July 2013 and June 2016 (relative risk [RR]: 0.75; 95% confidence interval [95% CI]: 0.67–0.85). According to the screening method, PPV23VE against death within 30 days of IPD onset, all IPD, and PPV23-serotype IPD was 32.5% (95% CI: 17.5–44.7%), 33.9% (95% CI: 25.2–41.5%) and 43.4% (95% CI: 34.4–51.2%), respectively. PPV23VE with the indirect cohort method was 39.0% (95% CI: 15.5–55.9%) for all PPV23 serotypes and 71.5% (95% CI: 44.2–85.4%) for 11 serotypes included in PPV23 but not in PCV13. During the period July 2008–June 2012, PPV23VE against PPV23-serotype IPD was 55.1% (95% CI: 27.2–72.3%). Conclusions PPV23 is able to prevent IPD and 30-day fatality in adults 75 years of age and older due to a combination of direct effects from PPV23 and indirect effects from PCV13. It might confer higher protection against PPV23-serotype IPD before the introduction of PCV13 program in children.

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Suicide in Nógrád County, Hungary, 1970-1994

Crisis ◽

10.1027//0227-5910.20.2.64 ◽

1999 ◽

Vol 20 (2) ◽

pp. 64-70 ◽

Cited By ~ 5

Author(s):

Tamás Zonda

Keyword(s):

High Risk ◽

Psychiatric Disorders ◽

Suicide Rate ◽

Risk Groups ◽

The Elderly ◽

Female Ratio ◽

Suicide Notes ◽

Suicidal Intention ◽

Male Female Ratio

The author examined completed suicides occurring over a period of 25 years in a county of Hungary with a traditionally low (relatively speaking) suicide rate of 25.8. The rates are clearly higher in villages than in the towns. The male/female ratio was close to 4:1, among elderly though only 1.5:1. The high risk groups are the elderly, divorced, and widowed. Violent methods are chosen in 66.4% of the cases. The rates are particularly high in the period April-July. Prior communication of suicidal intention was revealed in 16.3% of all cases. Previous attempts had been undertaken by 17%, which in turn means that 83% of suicides were first attempts. In our material 10% the victims left suicide notes. Psychiatric disorders were present in 60.1% of the cases, and severe, multiple somatic illnesses (including malignomas) were present in 8.8%. The majority of the data resemble those found in the literature.

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Targeting pneumococcal vaccination to high-risk groups: a feasibility study in one general practice

Postgraduate Medical Journal ◽

10.1136/pgmj.75.882.208 ◽

1999 ◽

Vol 75 (882) ◽

pp. 208-212 ◽

Cited By ~ 7

Author(s):

A N Siriwardena

Keyword(s):

General Practice ◽

High Risk ◽

Feasibility Study ◽

Pneumococcal Vaccination ◽

Risk Groups

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PCI Outcomes in High-Risk Groups (Diabetes Mellitus, Smoker, Chronic Kidney Disease and the Elderly)

Interventional Cardiology Clinics ◽

10.1016/j.iccl.2012.02.004 ◽

2012 ◽

Vol 1 (2) ◽

pp. 197-205 ◽

Cited By ~ 1

Author(s):

Anouska Moynagh ◽

Marie Claude Morice

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Risk Groups ◽

The Elderly

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Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales

Vaccine ◽

10.1016/j.vaccine.2012.09.019 ◽

2012 ◽

Vol 30 (48) ◽

pp. 6802-6808 ◽

Cited By ~ 142

Author(s):

Nick J. Andrews ◽

Pauline A. Waight ◽

Robert C. George ◽

Mary P.E. Slack ◽

Elizabeth Miller

Keyword(s):

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

The Elderly ◽

Polysaccharide Vaccine ◽

Pneumococcal Polysaccharide Vaccine ◽

England And Wales

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Invasive pneumococcal disease epidemiology and effectiveness of 23-valent pneumococcal polysaccharide vaccine in Alaska Native adults

Vaccine ◽

10.1016/j.vaccine.2006.11.065 ◽

2007 ◽

Vol 25 (12) ◽

pp. 2288-2295 ◽

Cited By ~ 31

Author(s):

Rosalyn J. Singleton ◽

Jay C. Butler ◽

Lisa R. Bulkow ◽

Debby Hurlburt ◽

Katherine L. O’Brien ◽

...

Keyword(s):

Invasive Pneumococcal Disease ◽

Alaska Native ◽

Pneumococcal Disease ◽

Polysaccharide Vaccine ◽

Pneumococcal Polysaccharide Vaccine ◽

Disease Epidemiology

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Effects of PCV7 and PCV13 on invasive pneumococcal disease and carriage in Stockholm, Sweden

European Respiratory Journal ◽

10.1183/13993003.01451-2015 ◽

2016 ◽

Vol 47 (4) ◽

pp. 1208-1218 ◽

Cited By ~ 82

Author(s):

Ilias Galanis ◽

Ann Lindstrand ◽

Jessica Darenberg ◽

Sarah Browall ◽

Priyanka Nannapaneni ◽

...

Keyword(s):

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Pneumococcal Vaccination ◽

Clinical Information ◽

Immunisation Programme ◽

The Elderly ◽

Older Children ◽

Serotype Distribution ◽

Vaccine Introduction ◽

Herd Protection

The effects of pneumococcal conjugated vaccines (PCVs) need to be investigated. In Stockholm County, Sweden, PCV7 was introduced in the childhood immunisation programme in 2007 and changed to PCV13 in 2010.Over 90% of all invasive isolates during 2005–2014 (n=2336) and carriage isolates, 260 before and 647 after vaccine introduction, were characterised by serotyping, molecular typing and antibiotic susceptibility, and serotype diversity was calculated. Clinical information was collected for children and adults with invasive pneumococcal disease (IPD).The IPD incidence decreased post-PCV7, but not post-PCV13, in vaccinated children. Beneficial herd effects were seen in older children and adults, but not in the elderly. The herd protection was more pronounced post-PCV7 than post-PCV13. PCV7 serotypes decreased. IPD caused by PCV13 serotypes 3 and 19A increased post-PCV7. Post-PCV13, serotypes 6A and 19A, but not serotype 3, decreased. The serotype distribution changed in carriage and IPD to nonvaccine types, also in nonvaccinated populations. Expansion of non-PCV13 serotypes was largest following PCV13 introduction. Serotype diversity increased and nonvaccine clones emerged, such as CC433 (serotype 22F) in IPD and CC62 (serotype 11A) in carriage. In young children, meningitis, septicaemia and severe rhinosinusitis, but not bacteraemic pneumonia, decreased.Pneumococcal vaccination leads to expansion of new or minor serotypes/clones, also in nonvaccinated populations.

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The Risk of Invasive Pneumococcal Disease Differs between Risk Groups in Norway Following Widespread Use of the 13-Valent Pneumococcal Vaccine in Children

Microorganisms ◽

10.3390/microorganisms9081774 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1774

Author(s):

Brita Askeland Winje ◽

Didrik Frimann Vestrheim ◽

Richard Aubrey White ◽

Anneke Steens

Keyword(s):

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Risk Group ◽

Population Data ◽

Risk Groups ◽

The Elderly ◽

Population Based ◽

Childhood Vaccination ◽

Medical Risk ◽

Icd 10

The elderly and adults with medical risk conditions remain at high risk of invasive pneumococcal disease (IPD), highlighting the importance of adequate preventive efforts. In an observational population-based study in Norway (pop ≥ 5 years, 2009–2017) covering six years post-PCV13 implementation, we explored the incidence and risk of IPD associated with age and comorbidities. We obtained the data on 5535 IPD cases from the Norwegian Surveillance System for Communicable Diseases and the population data from Statistics Norway. To define comorbidities, we obtained ICD-10 codes from the Norwegian Patient Registry for the cases and the Norwegian population. The average annual decrease in PCV13 IPD incidence was significant in all risk groups and decreased post-PCV13 introduction by 16–20% per risk group, implying a nondifferential indirect protection from the childhood vaccination. The IPD incidence remained high in the medical risk groups. The relative importance of medical risk conditions was 2.8 to 6 times higher in those aged 5–64 versus ≥65 years for all types of IPD, since age itself is a risk factor for IPD. In groups without medical risk, the risk of IPD was eight times higher in those aged ≥65 compared to those 5–64 years (RR 8.3 (95% CI 7.3–9.5)). Our results underscore the need for age- and risk-group-based prevention strategies.

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