Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older
Introduction
A large group of people, including those with various chronic conditions and those aged 65 years or older, have an increased risk of contracting influenza and its complications, including pneumococcal infection [1], [2], [3]. Despite the risk, the use of pneumococcal vaccine has been minimal in European countries [4]. Pneumococcal vaccine has not generally been recommended for the elderly, nor has it been included in national immunisation programmes [4], [5].
The limiting factor for giving recommendations is obviously the paucity of published data on the effectiveness of vaccine against pneumococcal pneumonia among elderly people. The 50–100% efficacy observed in cohort studies among young persons living in circumstances associated with a high attack rate of pneumococcal pneumonia [6], [7] cannot be directly applied to a nonepidemic situation among elderly people. There is, furthermore, little data on the incremental effectiveness of pneumococcal vaccine over influenza vaccine alone. Our own experience confirms the findings of previous studies that simultaneous administration of these two vaccines does not significantly affect the immunogenicity of either, nor does it increase the number of adverse reactions or their seriousness [8], [9], [10].
We present here our findings on the incremental effectiveness of pneumococcal vaccine in preventing pneumococcal pneumonia among 26925 persons aged 65 years or older who received either influenza and pneumococcal vaccine or only influenza vaccine.
Section snippets
Subjects and methods
All persons aged 65 years or older living in 23 administrative districts in northern Finland (cohort I, N=20640) were offered either influenza and pneumococcal vaccines or influenza vaccine alone in autumn 1992, and this was extended to a further 12 districts (cohort II, N=22860) in 1993. The vaccines were administered at the local health centres by the regular staff. Contraindications were, as usual, hypersensitivity to any component of the vaccines or an acute illness with fever. Terminally
Ethical aspects
Participation was voluntary for all health centres and vaccinees. The decision to participate was made at each health centre by its administration after discussion with other staff. The protocol was approved by the Ethics Committee of the Faculty of Medicine of the University of Oulu and by Oulu Municipal Health Centre. Permission to use data in the national registers was given by the Ministry of Social Affairs and Health, the National Research and Development Centre for Welfare and Health and
The vaccination groups
The total number of persons enrolled was 26,925 (Table 1). In autumn 1992 (cohort I) 4973 persons received influenza vaccine and 4902 both influenza and pneumococcal vaccine (47.8% of those aged 65 years or older living in the districts concerned). The corresponding figures for cohort II in autumn 1993 were 7972 and 9078 (74.6% of those aged 65 years or older living in those districts). Within each cohort the two vaccination groups were similar in their distribution by sex and age and in their
Discussion
No evidence of any incremental effectiveness of the 23-valent pneumococcal polysaccharide vaccine given together with influenza vaccine in preventing pneumonia was observed over the protection afforded by the influenza vaccine alone. The result is concordant with those of several previous studies with pneumococcal vaccine in this age group [18], [19], [20], whereas a protective effect was found among nursing home residents in France [21] and in a subgroup of patients with an increased risk of
Conclusion
This study did not point to any incremental protective effectiveness against pneumonia attributable to pneumococcal vaccine over influenza vaccine alone. The size of the population, 38,000 person years of follow-up, was nevertheless insufficient to exclude the possibility of a protective effectiveness of 20% or less. Efficacy rate is a critical point, when calculating the cost effectiveness of pneumococcal vaccine, in that a decrease in efficacy from 100 to 40%, for example, would increase the
Acknowledgments
This study was supported by grant 8474 from the Academy of Finland. The vaccines, together with a grant which made the serological diagnoses possible, were donated by Pasteur–Mérieux, Serums and Vaccins, Lyon, France. We wish to thank Reijo Pyhälä (KTL, Helsinki) for the data on influenza seasons, Juhani Eskola (KTL, Helsinki) and Camilla Jokinen (Kuopio University Hospital) for their critical reading of the manuscript and Riitta Lehtola, Aili Hökkä and Sirpa Raiskio (KTL, Oulu) for their
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2016, International Journal of Infectious DiseasesCitation Excerpt :PCV13 is approved for use in children aged 6 weeks and over and ACIP recommends its use in all children aged 2 months and over.40–42 Although PPV23 is not highly immunogenic in children,43–45 it does confer short-lived protection in adults by preventing invasive disease.46–53 Multiple studies have shown that the pneumococcal conjugate vaccines are more effective than the polysaccharide vaccine in preventing invasive and non-invasive infections in children less than 5 years old54–57 and adults (>65 years old)58,59 and for preventing pneumococcal disease in immunocompromised patients.60,61