# 4653
One of the problems inherent in giving vaccines to the elderly is that their older immune systems tend to mount a less-than-robust response, often leading to sub-optimal protection.
Recently a study appearing in the journal Clinical Infectious Diseases has called into question the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV or PPSV) in preventing deaths from repeat bouts of CA-pneumonia among the elderly.
This result, although disappointing, is not unlike that which we’ve seen with the seasonal flu vaccine.
Those over 65 - who are most at risk from dying from seasonal influenza - appear to derive the least amount of protection from our current flu shot formulations.
It should be noted that most researchers believe that – at least among those seniors who are reasonably healthy – the flu shot provides some level of protection.
How much varies from year-to-year and from person-to-person.
You’ll find a number of blogs here, going back several years on this topic, including:
Another Study: Flu Vaccines Do Not Reduce Mortality Rates In The Elderly
Study: Flu Vaccines And The Elderly
Flu Shots For The Elderly May Have Limited Benefits
Roughly two years ago we learned (see Vaccines: Sometimes You Just Need A Bigger Hammer) of a study conducted by Sanofi-Pasteur where several thousand people over the age of 65 were given a flu vaccine with 4 times the antigen of a standard shot.
Instead of 15ug of antigen per strain, these shots contained 60ug.
Those who received the enhanced shot developed a significantly stronger immune response than those who received the standard dose.
In March, ACIP announced that this new formulation would be available along with standard flu shots this fall, but did not announce a preference for one shot over the other.
Those interested should discuss this option with their family physician.
While early testing has been promising, it will probably take a year or two of field use before we have any idea of the relative impact of this new flu vaccine.
This new study on the PPV is entitled:
Impact of the Pneumococcal Vaccine on Long‐Term Morbidity and Mortality of Adults at High Risk for Pneumonia
Jennie Johnstone, Dean T. Eurich, Jasjeet K. Minhas, Thomas J. Marrie, Sumit R. Majumdar
You can read the entire abstract, but the gist is these researchers followed nearly 3,000 (mostly elderly) patients admitted to an Edmonton Hospital for CAP (Community Acquired Pneumonia) for 3.8 years.
One third of the patients had received PPV prior to admission or were vaccinated before they were discharged.
They found the readmission rate for vaccine preventable pneumonia over the next several years was the same, regardless of whether they received the PPV.
Conclusions One‐half of patients discharged from the hospital after pneumonia die or are subsequently hospitalized with a vaccine‐preventable infection within 5 years.
PPV was not associated with a reduced risk of death or hospitalization. Better pneumococcal vaccination strategies are urgently needed.
The standard caveats apply, of course. This is just one study, and additional research is needed.
As with the flu shots, most researchers continue to believe that getting the PPV vaccine has benefits for seniors.
Some studies have indicated that those vaccinated tend to have less severe pneumonias than those who haven’t received the shot.
And some researchers believe that we’d see better results among the elderly if they received the PPV vaccine earlier in life.
Currently, the PPV is recommended for those over 65 and those under 65 with specific risk factors for pneumonia. That includes smokers and those with asthma.
Admittedly, the PPV isn’t perfect.
But given its safety, and the potential benefits (even if limited in the elderly) of vaccination, until something better comes along, the lead author of this study still believes there is value in getting the PPV.
I certainly don’t regret getting mine.
