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

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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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Evolution of vaccination rates after the implementation of a free systematic pneumococcal vaccination in Catalonian older adults: 4-years follow-up
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“However, in the last published meta-analysis, Melegaro[15] concluded that the PPV provides 65% protection against invasive pneumococcal disease in the general elderly population, having a moderate 20% effect in the high risk elderly.”
BackgroundInfluential
Cost-effectiveness of the introduction of the pneumococcal polysaccharide vaccine in elderly Colombian population
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Elston, J. W. T., SANTANIELLO-NEWTON, A., Meigh, J. A., HARMER, D., Allgar, V. L., Allison, T., Richardson, G. A., Meigh, R. E., Palmer, S. R., & Barlow, G. D. (2011) · Epidemiology and Infection · doi:10.1017/s0950268811001907 · Cited by 31
“There is controversy about the effectiveness of PPV23 in older adults [3–6].”
Background
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Immunization for the Elderly
Bader, M. S. (2007) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e318156b4bc · Cited by 30
The cost-effectiveness of pneumococcal vaccination in healthy adults over 50: An exploration of influential factors for Belgium
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Adult vaccination
Swanson, K. A., Schmitt, H. J., Jansen, K. U., & Anderson, A. S. (2014) · Human Vaccines & Immunotherapeutics · doi:10.4161/hv.35858 · Cited by 33
Effectiveness of 23-valent pneumococcal polysaccharide vaccine on diabetic elderly
Kuo, C.-S., Lu, C., Chang, Y., Yang, K., Hung, S.-H., Yang, M., Chang, H., Huang, C.-T., Hsu, C., & Huang, K. (2016) · Medicine · doi:10.1097/md.0000000000004064 · Cited by 30
Multiplex PCR for Identification of Seven Streptococcus pneumoniae Serotypes Targeted by a 7-Valent Conjugate Vaccine
O’Halloran, D. M., & CAFFERKEY, M. T. (2005) · Journal of Clinical Microbiology · doi:10.1128/jcm.43.7.3487-3490.2005 · Cited by 28
“However, in a healthy elderly population, the polysaccharide vaccine provides relatively efficient protection against invasive pneumococcal disease (14).”
Background
Rationale and design of the CAPAMIS study: Effectiveness of pneumococcal vaccination against community-acquired pneumonia, acute myocardial infarction and stroke
Vila-Córcoles, Á., Gondar, O. O., de Diego‐Cabanes, C., Serrano, E. S., Raga, X., & Fuentes-Bellido, C. M. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-25 · Cited by 27
The role of Pneumococcal vaccine
Braido, F., Bellotti, M., Maria, A. D., Cazzola, M., & Canonica, G. W. (2008) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2008.04.001 · Cited by 27
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“Contrary to these immune impairments, the overall efficacy of vaccine was reported to be between 56 and 70% (5, 15, 44), which is similar to what has been reported (65 to 81%) for those without diabetes (20, 33, 34, 43).”
Result
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Esposito, S., Durando, P., Bosis, S., Ansaldi, F., Tagliabue, C., & Icardi, G. (2014) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2013.12.004 · Cited by 25
Illness representations on pneumonia and pneumococcal vaccination uptake among community-living Chinese people with high-risk conditions aged ≥65 years --- a population-based study
Wang, Z. J., Fang, Y., Dong, W., Lau, M. M. C., & Mo, P. K. H. (2020) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2020.1814653 · Cited by 26
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Cadeddu, C., de Waure, C., Gualano, M. R., Nardo, F. D., & Ricciardi, G. W. (2015) · Journal of preventive medicine and hygiene · doi:10.15167/2421-4248/jpmh2012.53.2.325 · Cited by 23
Maternal Immunization with Pneumococcal Surface Protein A Protects against Pneumococcal Infections among Derived Offspring
Kono, M., Hotomi, M., Hollingshead, S. K., Briles, D. E., & Yamanaka, N. (2011) · PLoS ONE · doi:10.1371/journal.pone.0027102 · Cited by 24
“However, this polysaccharidebased vaccines evoke little or no immune response in infants younger than 2 years of age because of the weak immunogenicity of its T cell independent polysaccharides [3,4].”
Background
Vaccinate your child and save its grandparents from a heart attack? Current perspectives in antipneumococcal vaccination
Vila-Córcoles, Á. (2009) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2009.02149.x · Cited by 23
Pneumococcal vaccination in older adults in the era of childhood vaccination: Public health insights from a Norwegian statistical prediction study
Steens, A., Vestrheim, D. F., & de Blasio, B. F. (2015) · Epidemics · doi:10.1016/j.epidem.2015.01.001 · Cited by 22
Impact of the RxVaccinate program for pharmacy-based pneumococcal immunization: A cluster-randomized controlled trial
Westrick, S. C., Owen, J. A., Hagel, H. P., Owensby, J. K., & Lertpichitkul, T. (2016) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2015.11.010 · Cited by 22
Pneumococcal vaccine in the elderly: a useful but forgotten vaccine
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The epidemiology of invasive pneumococcal disease in older adults from 2007 to 2014 in Ontario, Canada: a population-based study
Desai, S. N., Policarpio, M. E., Wong, K., Gubbay, J. B., Fediurek, J., & Deeks, S. L. (2016) · CMAJ Open · doi:10.9778/cmajo.20160035 · Cited by 20
“A comparison of meta-analyses by Melegaro and Edmunds 29 showed a vaccine effectiveness of 50%–80% against invasive pneumococcal disease in older adults.”
Result
Immunizations in the elderly: do they live up to their promise?
Herndler‐Brandstetter, D., Cioca, D., & Grubeck‐Loebenstein, B. (2006) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-006-0267-8 · Cited by 20
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“A 23-valent polysaccharide pneumococcal vaccine has been available for 30 years.(3) Meta-analyses have produced inconsistent results regarding the evidence of the effectiveness of pneumococcal vaccination.”
Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica
Palma, I. V., Mosquera, R., Demier, C., Vay, C. A., Famiglietti, A. M. R., & Luna, C. M. (2012) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37132012000400003 · Cited by 19
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“However, controversy over the efficacy of the 23-valent PPV has continued for many years and is still not fully resolved (Amentetal.,2000; Melegaro&Edmunds,2004b ).Although data from randomized studies have failed to show that the PPV is effective in preventing pneumococcal pneumonia or death in adults, there is evide…”
Influential
Epidemiología de la neumonía adquirida en la comunidad
Aramburu, M. I. I., Beguiristain, M. A., Carretero, M. J. I., Campos, J. M., Perez, P. E., & Gorosabel, R. G. (2013) · Atención Primaria · doi:10.1016/j.aprim.2013.05.003 · Cited by 18
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A review of the evidence to inform pneumococcal vaccine recommendations for risk groups aged 2 years and older
Steens, A., Vestrheim, D. F., Aaberge, I. S., WIKLUND, B. S., Storsæter, J., Bergsaker, M. A. R., Rønning, K., & Furuseth, E. (2014) · Epidemiology and Infection · doi:10.1017/s0950268814001514 · Cited by 17
“Protection against pneumonia is generally poor [68, 70, 71].”

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: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
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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The 23-Valent Pneumococcal Polysaccharide Vaccine. Part I. Efficacy of PPV in the Elderly: A Comparison of Meta-Analyses

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