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Cited by 185Pneumonia and Respiratory InfectionsBacterial Infections and VaccinesMicrobial infections and disease research

The 23-Valent Pneumococcal Polysaccharide Vaccine. Part I. Efficacy of PPV in the Elderly: A Comparison of Meta-Analyses

Melegaro, Alessia, Edmunds, W. John·2004·European Journal of Epidemiology
DOI 10.1023/b:ejep.0000024701.94769.98
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Abstract

A 23-valent polysaccharide pneumococcal vaccine (PPV) has been available in the UK for more than 20 years and is currently recommended for use in high-risk groups (HRG) of 2+ years of age. The degree of protection afforded by the PPV remains a critical issue, although a number of randomised clinical trials and case-control studies (CCS) have been published. The aim of this work is to review the estimates on the efficacy of PPV against pneumococcal pneumonia and invasive pneumococcal disease (IPD) in the elderly and to perform a meta-analysis in order to obtain a pooled estimate of the level of protection in high and low risk individuals. These two groups of individuals are at the centre of the current debate on whether or not to extend the vaccination programme to all elderly individuals 65+. Only randomised and quasi-randomised studies are included in the analysis and results are compared with previous meta-analyses. The effect of the inclusion of observational studies is investigated in the sensitivity analysis. When taken with the results of other meta-analyses and observational studies, it appears that PPV offers protection against IPD in the general elderly population (VE = 65%; 95% CI: -49-92%) whereas it has a moderate effect in the high-risk elderly (VE = 20%; 95% CI: -188-78%). The vaccine has little or no effect against pneumonia (VE = 16% in the general elderly and -20% in HRG).

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  • The immune system changes with age in nearly every aspect, generally leading to weaker pathogen immunity.

    “The immune system changes with age in nearly every aspect, generally resulting in a decline in pathogen immunity with increased age.”

    From SARS-CoV-2, COVID-19 and the aging immune system (2021) · cites this paper as [3]

  • Ageing is associated with high morbidity and mortality from various infections and with substantially lower vaccine efficacy.

    “ageing is associated with high morbidity and mortality rates for various infections and significant reductions in vaccine efficacy1-6”

    From SARS-CoV-2, COVID-19 and the aging immune system (2021) · cites this paper as [3]

  • The 23-valent polysaccharide vaccine against S. pneumoniae has efficacy against invasive disease, but efficacy against pneumonia is frequently in doubt because clinical study results are inconclusive.

    “A 23-valent polysaccharide vaccine against Streptococcus pneumoniae has been used for many years in the older population. Meta-analyses reported efficacy against invasive disease, but the efficacy against pneumonia is frequently in doubt, as results from clinical studies are inconclusive [167].”

    From Aging of the immune system: Focus on inflammation and vaccination (2016) · cites this paper as [167]

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Authors
Melegaro, A., & Edmunds, W. J.
Affiliations
  • University of Warwick (GB)
  • City, University of London (GB)
Corresponding author
Melegaro, Alessia
ORCID
Melegaro, Alessia
Venue
European Journal of Epidemiology
Publisher
Springer Science and Business Media LLC
Published
2004-04
Volume
19
Issue
4
Pages
353-363
ISSN
  • 0393-2990 (ISSN-L)
  • 1573-7284
DOI
10.1023/b:ejep.0000024701.94769.98
OpenAlex
W2010088615
Cited by
185
References
39
Citations by year
2026: 2 · 2025: 2 · 2022: 3 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 11 · 2015: 9 · 2014: 8 · 2013: 13 · 2012: 15
FWCI
10.78
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • European Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio istituzionale della Ricerca - Bocconi (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
Keywords
23-valent pneumococcal polysaccharide vaccine, vaccine efficacy, older adults, invasive pneumococcal disease, pneumococcal pneumonia, high-risk groups
MeSH terms
Aged, Humans, Pneumococcal Infections, Pneumonia, Pneumococcal, Confidence Intervals, Odds Ratio, Randomized Controlled Trials as Topic, Risk Assessment, Pneumococcal Vaccines

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