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Reducing pneumococcal risk in people aged 65 years and over

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Role of general practice

The infant pneumococcal vaccination program in Australia has an average ­coverage of 93%, but uptake of 23vPPV remains suboptimal, at 54% national coverage in 2009 and less than 50% in 2015-16 based on a NSW Health survey.14 Serotype replacement is occurring, with an increase in non-vaccine-type pneumococcal disease in Australia. Nevertheless, more effective prevention is possible if coverage rates are increased. 



Despite the availability and use of 23vPPV in older people, making an impact on ­pneumococcal disease rates has been ­challenging. This is largely because of inadequate coverage, suboptimal effectiveness of this vaccine, serotype replacement and pneumococcal disease due to serotypes not covered in vaccines. In line with many other countries, Australia is reviewing its vaccine policy in older people now that 13vPCV has been licensed in this group. When patients request 13vPCV as well as 23vPPV, or their healthcare provider deems this desirable, then 13vPCV should either be given first or delayed for 12 months if 23vPPV has already been received.     MT


1.    GBD 2013 Mortality and Causes of Death Collaborators. Global, regional and national age-specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study. 2013. Lancet 2015; 385: 117-171. 
2.    Earle K, Williams S. Burden of pneumococcal disease in adults aged 65 years and older: an Aus­tralian perspective. Pneumonia (Nathan) 2016; 8: 9. 
3.    Jayasinghe S, Menzies R, Chiu C, et al. Long-term impact of a ‘3+0’ schedule for 7 and 13 valent pneumococcal conjugate vaccines on invasive pneumococcal disease in Australia, 2002-2014. Clin Infect Dis 2017; 64: 175-183.
4.    Andrews NJ, Waight PA, George RC, Slack MP, Miller E. Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England and Wales. Vaccine 2012; 30: 6802-6808. 
5.    Shiri T, Datta S, Madan J, et al. Indirect effect of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease: a systematic review and meta-analysis. Lancet Glob Health 2016; 5: e51-e59.
6.    van Werkhoven CH, Hollingsworth RC, Huijts SM, et al. Pneumococcal conjugate vaccine herd effects on non-invasive pneumococcal pneumonia in elderly. Vaccine 2016; 34: 3275-3282. 
7.    Bonten M, Huijts SM, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumo­coccal pneumonia in adults. N Engl J Med 2015; 372: 1114-1125.
8.    Suzuki M, Dhoubhadel BG, Ishifuji T, et al; Adult Pneumonia Study Group-Japan (APSG-J). Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study. Lancet Infect Dis 2017; 17: 313-321. 
9.    Ochoa-Gondor O, Vila-Corcoles A, Rodriguez-Blanco T, et al. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged ≥60 years: 3 years of follow-up in the CAPAMIS study. Clin Infect Dis 2014; 58: 909-917.
10.    Maruyama T, Taguchi O, Neiderman NS, et al. Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial. BMJ 2010; 340: c1004.
11.    Australian Technical Advisory Group on Immunisation (ATAGI). Pneumococcal disease. In: Australian immunisation handbook. Canberra: Australian Government Department of Health; 2018. Available online at: (accessed February 2019). 
12.    Australian and New Zealand Society for Geriatric Medicine. Position statement no. 7. Immunisation of older people – revision number 3, 2018. Available online at: (accessed February 2019).
13.    Papadatou I, Spoulou V. Pneumococcal vaccination in high-risk individuals: are we doing it right? Clin Vaccine Immunol 2016; 23: 388-395.
14.    HealthStats NSW. Influenza and pneumococcal disease immunisation. Available online at: (accessed February 2019).
COMPETING INTERESTS: Professor Van Buynder has received support for research, education and marketing, travel and/or advisory board activities from Seqirus and Pfizer, manufacturers of pneumococcal vaccines.