Pneumococcal Vaccination in Older Adults
Pneumococcal Vaccination in Older Adults
Attempts to develop a vaccine against S pneumoniae began as early as 1911, with renewed interest developing in the 1960s; patients were still dying from pneumococcal disease despite treatment with antibiotic therapy. Two types of vaccines are currently available: a polysaccharide vaccine composed of purified preparations of pneumococcal capsular polysaccharides and a conjugate vaccine of capsular polysaccharides linked to a nontoxic variant of a diphtheria toxin. The first pneumococcal vaccine was FDA-approved in 1977 and contained purified antigen from 14 types of pneumococcal bacteria. This was replaced in 1983 with a 23-valent polysaccharide vaccine (PPSV23, Pneumovax 23; Merck) containing antigens from 23 types of S pneumoniae that are known to cause 88% of bacteremic pneumococcal disease. In 2000, the first conjugate vaccine was developed (PCV7) but has since been replaced by the currently available PCV13 (Prevnar 13; Pfizer) in 2010.
PPSV23 vaccination has demonstrated an overall prevention rate of 60% to 70% of invasive disease. It is important to note that PPSV23 has not demonstrated consistent protection against noninvasive pneumococcal pneumonia in clinical trials, and for this reason providers should avoid referring to PPSV23 as a "pneumonia vaccine." PCV13 has been shown to prevent 75% of invasive pneumococcal disease in adults >65 years of age and is 45% effective in preventing non-invasive pneumonia caused by the 13 strains it covers.
History and Effectiveness
Attempts to develop a vaccine against S pneumoniae began as early as 1911, with renewed interest developing in the 1960s; patients were still dying from pneumococcal disease despite treatment with antibiotic therapy. Two types of vaccines are currently available: a polysaccharide vaccine composed of purified preparations of pneumococcal capsular polysaccharides and a conjugate vaccine of capsular polysaccharides linked to a nontoxic variant of a diphtheria toxin. The first pneumococcal vaccine was FDA-approved in 1977 and contained purified antigen from 14 types of pneumococcal bacteria. This was replaced in 1983 with a 23-valent polysaccharide vaccine (PPSV23, Pneumovax 23; Merck) containing antigens from 23 types of S pneumoniae that are known to cause 88% of bacteremic pneumococcal disease. In 2000, the first conjugate vaccine was developed (PCV7) but has since been replaced by the currently available PCV13 (Prevnar 13; Pfizer) in 2010.
PPSV23 vaccination has demonstrated an overall prevention rate of 60% to 70% of invasive disease. It is important to note that PPSV23 has not demonstrated consistent protection against noninvasive pneumococcal pneumonia in clinical trials, and for this reason providers should avoid referring to PPSV23 as a "pneumonia vaccine." PCV13 has been shown to prevent 75% of invasive pneumococcal disease in adults >65 years of age and is 45% effective in preventing non-invasive pneumonia caused by the 13 strains it covers.
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