Study: Pneumococcal Vaccine In Elderly Disappoints

 

 

# 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.

CDC Promoting Better Uptake Of PPSV in Adults

 

# 4003

 

 

Although I don’t offer medical advice in this blog, I have suggested on numerous occasions that people should consult with their health care provider about the advisability of taking the Pneumococcal polysaccharide vaccine (PPSV) – even if you aren’t sure you fall into a recommended category.

A few of my blogs on the subject include:

An Appropriate Level Of Concern (Revisited)

Referral: Effect Measure On Pneumococcal Vaccines

CDC Issues Pneumococcal Vaccine Recommendations

 

This week Dr. Anne Schuchat,  Director of of the CDC's National Center for Immunization and Respiratory Diseases, sent out a letter to health care providers reminding them of the value of the (PPSV) pneumococcal vaccine for adults.

 

With an influenza pandemic underway, the chances of developing a serious bacterial pneumonia, secondary to the flu, is higher than ever.   

 

The PPSV vaccine won’t prevent all bacterial pneumonias, but it can significantly reduce the number of those who will be affected. 

 

 

Letter to Providers Promoting PPSV for Adults

November 10, 2009 11:00 AM ET

Dear Provider,

 

We’re writing to urge you to make sure all your patients with indications have received the pneumococcal vaccine.  Approximately 70 million persons with existing pneumococcal polysaccharide vaccine (PPSV) indications are unvaccinated (National Health Interview Survey, 2007). During the influenza pandemics of the 20th century, secondary bacterial pneumonia was a frequent cause of illness and death and Streptococcus pneumoniae (pneumococcus) was reported as the most common etiology. With the current 2009 H1N1 influenza pandemic, and as with seasonal influenza, pneumococcal infections are once again being found among fatal cases in both children and adults.

 

During influenza outbreaks, pneumococcal vaccines may be useful in preventing secondary pneumococcal infections. As you know, PPSV is available for prevention of pneumococcal disease among adults and children 2 years of age and older who are at increased risk for pneumococcal disease, but many of those with indications have not yet received the vaccine.  A 7-valent pneumococcal conjugate vaccine is recommended for all children <5 years of age.

 

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends a single dose of PPSV for all people 65 years and older and for persons 2 through 64 years of age with certain high-risk conditions (Box). People in these groups are at increased risk of pneumococcal disease as well as serious complications due to influenza virus infection. A single revaccination with PPSV is recommended at least 5 years after initial vaccination for people 65 years and older who were first vaccinated before age 65. A single revaccination is also recommended for people at highest risk of disease, such as those who have functional and anatomical asplenia, and those who have HIV infection, AIDS or malignancy and have at least five years elapsed from receipt of first vaccination.

 

All people who have existing indications for PPSV should be vaccinated according to current ACIP recommendations during this 2009-2010 influenza season, which will likely include circulation of both seasonal and 2009 H1N1 influenza viruses. Special emphasis should be placed on vaccinating adults under 65 years of age who have established high-risk conditions; PPSV coverage among this group is very low and this group may be more likely to develop secondary bacterial pneumonia after an influenza infection. Use of PPSV among people without current indications for vaccination is not recommended at this time.

 

Pneumococcal vaccine may be given at the same time as influenza vaccine. Visits for seasonal and 2009 H1N1 influenza vaccination provide a convenient time to evaluate patients for the need for pneumococcal vaccination. Because the indications for pneumococcal and seasonal influenza vaccines among adults are similar, the need for pneumococcal vaccination should be evaluated at the time of either seasonal influenza vaccination or 2009 H1N1 influenza vaccination. Persons who cannot remember if they’ve ever had pneumococcal vaccine should still be vaccinated.

 

Sincerely,

Anne Schuchat, MD
Director, National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

 

 

High-Risk Indications for Persons 2 through 64 Years of Age

• chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
• chronic pulmonary disease including chronic obstructive pulmonary disease and emphysema
• diabetes mellitus, alcoholism, chronic liver disease (including cirrhosis)
• cerebrospinal fluid leaks, cochlear implant
• functional or anatomic asplenia including sickle cell disease and splenectomy
• immunocompromising conditions including HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant
• residents of nursing homes or long-term care facilities

High-Risk Indications for Persons 19 through 64 Years of Age

• smoke cigarettes or have asthma