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Feature Article

Reducing pneumococcal risk in people aged 65 years and over

PAUL VAN BUYNDER
OPEN ACCESS

Figures

© JOHN BAVOSI/SPL
© JOHN BAVOSI/SPL

Abstract

Disease due to pneumococcus (Streptococcus pneumoniae) remains a major source of illness in older people. Conjugated pneumococcal vaccines are used extensively in national paediatric programs, whereas a 23-valent polysaccharide vaccine is mainly used in older people and high-risk groups. Data from the Netherlands have led to licensing of a conjugated pneumococcal vaccine for older people in Australia. This review examines current recommendations on pneumococcal vaccines.

Key Points

  • Pneumococcus (Streptococcus pneumoniae) remains a major cause of illness in older people and the most important pathogen globally in respiratory infection deaths.
  • A conjugated pneumococcal vaccine covering 13 serotypes (13vPCV) is used in the Australian paediatric program, and a polysaccharide vaccine covering 23 serotypes (23vPPV) is mainly used in older people and high-risk groups.
  • Both invasive and noninvasive disease rates due to serotypes covered in the childhood 13vPCV program are declining in older adults.
  • Data from a clinical trial in the Netherlands led to licensing of 13vPCV for older people in Australia in 2011, but this vaccine is not currently funded under the National Immunisation Program (NIP) for this group.
  • Coverage rates for 23vPPV in Australia are suboptimal; all older people presenting for influenza vaccine should have their pneumococcal vaccination status checked and should receive 23vPPV if they have not previously received it.
  • Recall and reminder systems should be used to ensure appropriately timed revaccination for those who require it.
  • If an older person is to receive both 23vPPV and 13vPCV then 13vPCV should be administered first, followed by 23vPPV eight weeks later.

Infections caused by pneumococcus (Streptococcus pneumoniae) may involve a normally sterile site, such as blood or joint fluid (known as invasive pneumococcal disease or IPD) but are more commonly local mucosal infections, such as community-acquired nonbacteraemic pneumonia (CAP). Pneumococcal infection remains a major source of illness in older people. Globally, across all age groups, pneumococcus remains the most important pathogen in deaths due to respiratory infections.1 

Data on IPD cases are relatively robust in many countries, but the contribution of pneumococcus to CAP is poorly understood. Assessing data for CAP with any cause and more specifically pneumococcal CAP is challenging as there is often no surveillance mechanism in place, and published studies have used various combinations of diagnostic tests, including blood culture, urinary antigen testing and sputum culture. 

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A review of national databases from 2004 to 2012 and published studies in Australia found the hospitalisation rate with pneumococcal pneumonia in people aged 65 years or over was 274 per 100,000 population, or 20% of all CAP hospitalisations.2 GP visits for pneumococcal CAP averaged 455 per 100,000 annually. The hospitalisation rate for IPD in 2012 was 19 per 100,000; thus pneumococcal CAP hospitalisation rates were 15-fold higher than for IPD and the costs to the healthcare system were determined to be about 30-fold higher.2 

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