The Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Carriage in the Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA) Study Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands 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. Cost-Effectiveness Analysis of Universal Vaccination of Adults Aged 60 Years with 23-Valent Pneumococcal Polysaccharide Vaccine versus Current Practice in Brazil Protective effects of the 23-valent pneumococcal polysaccharide vaccine in the elderly population: the EVAN-65 study. Effectiveness of the 13-valent pneumococcal conjugate vaccine in preventing invasive pneumococcal disease in children aged 7-59 months. A matched case-control study 23–valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double-blind, randomised and placebo controlled trial Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. Impact of pneumococcal vaccination on the incidence of pneumonia by HIV infection status among patients enrolled in the Veterans Aging Cohort 5-Site Study. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. Incremental Cost-Effectiveness of 13-valent Pneumococcal Conjugate Vaccine for Adults Age 50 Years and Older in the United States Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. 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.
Background The impact of pneumococcal conjugate vaccination on the prevalence of nasopharyngeal carriage with pneumococci and other bacteria in adults is unknown . The direct effects of the 13-valent pneumococcal conjugate vaccine ( PCV13 ) in community dwelling older adults was investigated as part of the r and omized controlled Community Acquired Pneumonia immunization Trial in Adults ( CAPiTA ) . Methods We determined the carriage of Streptococcus pneumoniae , Staphylococcus aureus , Haemophilus influenzae , and Moraxella catarrhalis before and 6 , 12 , and 24 months after vaccination using polymerase chain reaction (PCR)-based methods and conventional cultures of nasopharyngeal and oropharyngeal swab sample s in 1006 PCV13 recipients and 1005 controls . Serotyping of the 13 vaccine-type ( VT ) pneumococci was performed by PCR targeting capsular synthesis genes and Quellung reaction of isolates . Results Before r and omization and based on PCR , 339 of 1891 subjects had nasopharyngeal carriage with any pneumococci ( 17.9 % ) , and 114 of 1891 ( 6.0 % ) carried VT pneumococci . At 6 months after vaccination , VT pneumococcal carriage was significantly lower in PCV13 recipients than in the placebo group ( relative risk , 0.53 ; 95 % confidence interval , .35-.80 ; P = .04 ) . There was no difference between the groups at 12 and 24 months after vaccination . Carriage of non-VT pneumococci , S. aureus , H. influenzae , and M. catarrhalis did not change between groups . Conclusions In community-dwelling adults aged ≥65 years , a single dose of PCV13 seems to elicit a small and temporary reduction in VT carriage 6 months after vaccination . Neither replacement by non-VT serotypes nor impact on other nasopharyngeal bacteria was observed The Community-Acquired Pneumonia Immunization Trial in Adults ( CAPiTA ) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine ( PCV13 ) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects . We examined the cost-effectiveness of PCV13 vaccination in the Netherl and s. Using a Markov-type model , incremental cost-effectiveness ratios ( ICER ) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective . Estimates of quality -adjusted life-years ( QALYs ) , costs , vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospect i ve studies . The base-case was PCV13 vaccination of adults aged 65–74 years compared to no vaccination , assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use . Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted . The ICER for base-case was € 8650 per QALY ( 95 % CI 5750–17 100 ) . Vaccination of high-risk individuals aged 65–74 years was cost-saving and extension to medium-risk individuals aged 65–74 years yielded an ICER of € 2900 . Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of € 3100 . PCV13 vaccination is highly cost-effective in the Netherl and s. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries . Vaccinating the elderly with 13-valent pneumococcal conjugate vaccine is highly cost-effective BACKGROUND The benefits of using the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) are controversial . This study assessed clinical effectiveness of PPV23 in preventing community-acquired pneumonia ( CAP ) among the general population aged ≥ 60 years . METHODS This was a population -based cohort study involving 27 204 individuals aged ≥ 60 years in Tarragona , Spain , who were prospect ively followed from 1 December 2008 until 30 November 2011 . Primary outcomes were hospitalization for pneumococcal CAP ( bacteremic and nonbacteremic cases ) and all-cause CAP . All CAP cases were radiographically confirmed and vali date d by checking clinical records . Cox regression was used to evaluate the association between pneumococcal vaccination and the risk of each outcome . RESULTS Cohort members were followed for a total of 76 033 person-years ( 29 065 person-years for vaccinated subjects ) . Incidence rates ( per 1000 person-years ) were 0.21 for bacteremic pneumococcal CAP ( 0.14 vs 0.26 among vaccinated and unvaccinated subjects , respectively ) , 1.45 for nonbacteremic pneumococcal CAP ( 1.46 vs 1.44 ) , and 7.51 for all-cause CAP ( 7.19 vs 7.71 ) . In primary analyses including all cohort members , PPV23 did not appear to be effective against any analyzed outcome . However , a beneficial effect emerged in sensitive and stratified analyses . After multivariable adjustments , as compared with those never vaccinated , recent vaccination with PPV23 ( < 5 years ago ) was associated with reduced risks of bacteremic pneumococcal CAP ( hazard ratio [ HR ] , 0.38 ; 95 % confidence interval [ CI ] , .09 - 1.68 ) , nonbacteremic pneumococcal CAP ( HR , 0.52 ; 95 % CI , .29-.92 ) , overall pneumococcal CAP ( HR , 0.49 ; 95 % CI , .29-.84 ) , and all-cause CAP ( HR , 0.75 ; 95 % CI , .58-.98 ) . CONCLUSIONS Our data support a protective effect of recent PPV23 vaccination ( within previous 5 years ) against both pneumococcal and all-cause CAP Objective To evaluate the cost-effectiveness of introducing universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) into the National Immunization Program ( NIP ) in Brazil . Methods Economic evaluation using a Markov model to compare two strategies : ( 1 ) universal vaccination of adults aged 60 years  with one dose of PPV23 and 2 ) current practice ( vaccination of institutionalized elderly and elderly with underlying diseases ) . The perspective was from the health system and society . Temporal horizon was 10 years . Discount rate of 5 % was applied to costs and benefits . Clinical syndromes of interest were invasive pneumococcal disease ( IPD ) including meningitis , sepsis and others and pneumonia . Vaccine efficacy against IPD was obtained from a meta- analysis of r and omized control trials and r and omized studies , whereas vaccine effectiveness against pneumonia was obtained from cohort studies . Re source utilization and costs were obtained from the Brazilian Health Information Systems . The primary outcome was cost per life year saved ( LYS ) . Univariate and multivariate sensitivity analysis were performed . Results The universal vaccination strategy avoided 7,810 hospitalizations and 514 deaths , saving 3,787 years of life and costing a total of USD$31,507,012 and USD$44,548,180 , respectively , from the health system and societal perspective . The universal immunization would result in ICERs of USD$1,297 per LYS , from the perspective of the health system , and USD$904 per LYS , from the societal perspective . Conclusion The results suggest that universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) is a very cost-effective intervention for preventing hospitalization and deaths for IPD and pneumonia is this age group in Brazil BACKGROUND The 23-valent polysaccharide pneumococcal vaccine ( PPV ) is currently recommended for elderly persons and persons who are at high risk of infection . However , the effectiveness of the 23-valent PPV remains controversial . We assessed the effectiveness of this vaccine in older adults . METHODS A prospect i ve cohort study was conducted from January 2002 through April 2005 ; it included all community-dwelling individuals aged > or=65 years who were assigned to 1 of 8 primary health care centers in Tarragona , Spain ( 11,241 subjects ) . The primary outcomes were invasive pneumococcal disease , pneumococcal pneumonia , overall pneumonia rate , and death due to pneumonia . All cases were vali date d by a check of the clinical records . The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional hazard models , adjusted for age , sex , comorbidity , immunocompetence , and influenza vaccine status . RESULTS Pneumococcal vaccination was associated with significant reductions in the risk of hospitalization for pneumonia ( hazard ratio [ HR ] , 0.74 ; 95 % confidence interval [ CI ] , 0.59 - 0.92 ) and in the overall pneumonia rate ( HR , 0.79 ; 95 % CI , 0.64 - 0.98 ) . The incidence of invasive pneumococcal disease was low ( 64 cases per 100,000 person-years ) , and a considerable protective effect against invasive pneumococcal disease did not attain statistical significance ( HR , 0.60 ; 95 % CI , 0.22 - 1.65 ) . However , the vaccine showed a significant effectiveness of 45 % to prevent pneumococcal pneumonia ( HR , 0.55 ; 95 % CI , 0.34 - 0.88 ) . Finally , vaccination was associated with a significant 59 % reduction in the risk of death due to pneumonia among vaccinated subjects ( HR , 0.41 ; 95 % CI , 0.23 - 0.72 ) . CONCLUSIONS These results indicate that the 23-valent PPV effectively prevented pneumococcal pneumonia ( with or without bacteremia ) and decreased the rates of overall pneumonia and of mortality due to pneumonia in older adults , providing new arguments for systematic vaccination in the elderly population Background The 13-valent pneumococcal conjugate vaccine ( PCV13 ) was licensed based on the results of immunogenicity studies and correlates of protection derived from r and omized clinical trials of the 7-valent conjugate pneumococcal vaccine . We assessed the vaccination effectiveness ( VE ) of the PCV13 in preventing invasive pneumococcal disease ( IPD ) in children aged 7–59 months in a population with suboptimal vaccination coverage of 55 % . Methods The study was carried out in children with IPD admitted to three hospitals in Barcelona ( Spain ) and controls matched by hospital , age , sex , date of hospitalization and underlying disease . Information on the vaccination status was obtained from written medical records . Conditional logistic regression was made to estimate the adjusted VE and 95 % confidence intervals ( CI ) . Results 169 cases and 645 controls were included .  The overall VE of ≥1 doses  of PCV13 in preventing IPD due to vaccine serotypes was 75.8 % ( 95 % CI , 54.1–87.2 ) and 90 % ( 95 % CI , 63.9–97.2 ) when ≥2 doses before 12 months , two doses on or after 12 months or one dose on or after 24 months , were administered . The VE of ≥1 doses was 89 % ( 95 % CI , 42.7–97.9 ) against serotype 1 and 86.0 % ( 95 % CI , 51.2–99.7 ) against serotype 19A . Serotype 3 showed a non-statistically significant effectiveness ( 25.9 % ; 95 % CI , -65.3 to 66.8 ) . Conclusions The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7–59 months was good and , except for serotype 3 , the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually BACKGROUND Infection with Streptococcus pneumoniae is a frequent and serious problem for HIV-immunosuppressed adults .  Vaccination is recommended in the USA and Europe , but there are no prospect i ve data that show vaccine efficacy . METHODS 1392 ( 937 female ) HIV-1-infected adults in Entebbe , Ug and a , were enrolled . 697 received 23-valent pneumococcal polysaccharide vaccine and 695 received placebo . The primary endpoint was first event invasive pneumococcal disease . Secondary endpoints included vaccine serogroup-specific invasive disease , all ( probable and definite ) pneumococcal events , all-cause pneumonia , and death . FINDINGS First invasive events occurred in 25 individuals ( 24 bacteraemias , one pyomyositis ) , 15 in the vaccine arm and ten in the placebo arm ( hazard ratio [ HR ] 1.47 ; 95 % CI 0.7 - 3.3 ) . 22 isolates ( 88 % ) were of vaccine-specific serogroups with 15 events in the vaccine arm compared with seven in the placebo arm ( HR 2.10 ; 0.9 - 5.2 ) . All pneumococcal events had a similar distribution ( 20 vs 14 ; HR 1.41 ; 0.7 - 2.8 ) though all-cause pneumonia was significantly more frequent in the vaccine arm ( 40 vs 21 ; HR 1.89 ; 1.1 - 3.2 ) . Mortality was unaffected by vaccination . INTERPRETATION 23-valent pneumococcal polysaccharide vaccination is ineffective in HIV-1-infected Ug and an adults and probably has little , or no , public health value elsewhere in sub-Saharan Africa . Increased rates of pneumococcal disease in vaccine recipients may necessitate a re appraisal of this intervention in other setting AIM To determine if patients with untreated chronic lymphocytic leukemia ( CLL ) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine ( PCV13 ) , Prevenar13 ® , compared to a 23-valent pneumococcal polysaccharide vaccine ( PPSV23 ) , Pneumovax ® , in terms of immune response . BACKGROUND Streptococcus pneumoniae causes substantial morbidity in patients with CLL , a group known to respond poorly to polysaccharide vaccines . Comparative studies with conjugated vaccines are lacking . METHODS 128 treatment naïve CLL patients from eight hematology clinics in Sweden were r and omized to vaccination with PCV13 ( n = 63 ) or PPSV23 ( n = 65 ) after stratification by IgG level and CLL clinical stage ( Rai ) . Blood sample s for evaluation of immune response were obtained at baseline , and at one and six months after vaccination . Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay ( OPA ) and enzyme-linked immunosorbent assay ( ELISA ) . RESULTS PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination , measured as OPA geometric mean titers ( GMTs ) . Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA , were higher than those elicited by PPSV23 in half of the common serotypes , both after one and six months . PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes , regardless of analysis method or time point of analysis . Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration . Both vaccines were well tolerated . CONCLUSIONS In patients with previously untreated CLL , the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines . We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease BACKGROUND Human immunodeficiency virus (HIV)-infected persons have a high incidence of pneumonia and pneumococcal disease . Benefits of vaccination with the 23-valent pneumococcal polysaccharide vaccine ( PPV ) among these patients continue to be debated . METHODS The impact of PPV vaccination on the incidence of pneumonia events ( i.e. , the composite of pneumococcal pneumonia and pneumonia due to nonspecified organisms ) was examined among participants in the Veterans Aging Cohort 5-Site Study , an ongoing prospect i ve study of HIV-infected patients matched to an HIV-uninfected control group . Date s of PPV vaccination and pneumonia were determined by retrospective review of electronic medical records . Time to events was measured for up to 2 years from PPV vaccination or from enrollment for vaccinated and unvaccinated patients , respectively . Kaplan-Meier and Cox proportional hazards regression methods were used to examine the incidence of pneumonia by HIV infection and PPV vaccination status . RESULTS Among 692 HIV-uninfected and 934 HIV-infected study participants , 59 % were vaccinated with PPV . The 2-year incidence of pneumonia was 6 % ( 97 participants developed pneumonia ) . HIV-infected patients had a higher rate of pneumonia ( hazard ratio , 5.81 ; 95 % confidence interval , 3.15 - 10.71 ) ; overall , vaccinated patients showed a trend toward lower risk of pneumonia ( hazard ratio , 0.75 ; 95 % confidence interval , 0.50 - 1.13 ) . Among HIV-infected patients , after controlling for HIV-specific and other variables , vaccination significantly reduced the risk of pneumonia ( hazard ratio , 0.65 ; 95 % confidence interval , 0.42 - 1.00 ) ; current smoking , low hemoglobin level , and low CD4 cell count significantly increased such risk . The effect of PPV vaccination  among HIV-uninfected patients was not significant . CONCLUSIONS Among HIV-infected patients , PPV vaccination offered protection against pneumonia . Smoking cessation needs to be pursued as an additional strategy for preventing pneumonia BACKGROUND Acute respiratory tract infections caused by Streptococcus pneumoniae are a leading cause of morbidity and mortality in young children . We evaluated the efficacy of a 9-valent pneumococcal conjugate vaccine in a r and omized , double-blind study in Soweto , South Africa . METHODS At 6 , 10 , and 14 weeks of age , 19,922 children received the  9-valent pneumococcal polysaccharide vaccine conjugated to a noncatalytic cross-reacting mutant of diphtheria toxin ( CRM197 ) , and 19,914 received placebo .  All children received Haemophilus influenzae type b conjugate vaccine .  Efficacy and safety were analyzed according to the intention-to-treat principle . RESULTS Among children without human immunodeficiency virus ( HIV ) infection , the vaccine reduced the incidence of a first episode of invasive pneumococcal disease due to serotypes included in the vaccine by 83 percent ( 95 percent confidence interval , 39 to 97 ; 17 cases among controls and 3 among vaccine recipients ) . Among HIV-infected children , the efficacy was 65 percent ( 95 percent confidence interval , 24 to 86 ; 26 and 9 cases , respectively ) . Among children without HIV infection , the vaccine reduced the incidence of first episodes of radiologically confirmed alveolar consolidation by 20 percent ( 95 percent confidence interval , 2 to 35 ; 212 cases in the control group and 169 in the vaccinated group ) in the intention-to-treat analysis and by 25 percent ( 95 percent confidence interval , 4 to 41 ; 158 and 119 cases , respectively ) in the per- protocol analysis ( i.e. , among fully vaccinated children ) . The incidence of invasive pneumococcal disease caused by penicillin-resistant strains was reduced by 67 percent ( 95 percent confidence interval , 19 to 88 ; 21 cases in the control group and 7 in the vaccinated group ) , and that caused by strains resistant to trimethoprim-sulfamethoxazole was reduced by 56 percent ( 95 percent confidence interval , 16 to 78 ; 32 and 14 cases , respectively ) . CONCLUSIONS Vaccination with a 9-valent pneumococcal conjugate vaccine reduced the incidence of radiologically confirmed pneumonia . The vaccine also reduced the incidence of vaccine-serotype and antibiotic-resistant invasive pneumococcal disease among children with and those without HIV infection BACKGROUND Pneumococcal polysaccharide conjugate vaccines prevent pneumococcal disease in infants , but their efficacy against pneumococcal community-acquired pneumonia in adults 65 years of age or older is unknown . METHODS In a r and omized , double-blind , placebo-controlled trial involving 84,496 adults 65 years of age or older , we evaluated the efficacy of 13-valent polysaccharide conjugate vaccine ( PCV13 ) in preventing first episodes of vaccine-type strains of pneumococcal community-acquired pneumonia , nonbacteremic and noninvasive pneumococcal community-acquired pneumonia , and invasive pneumococcal disease . St and ard laboratory methods and a serotype-specific urinary antigen detection assay were used to identify community-acquired pneumonia and invasive pneumococcal disease . RESULTS In the per- protocol analysis of first episodes of infections due to vaccine-type strains , community-acquired pneumonia occurred in 49 persons in the PCV13 group and 90 persons in the placebo group ( vaccine efficacy , 45.6 % ; 95.2 % confidence interval [ CI ] , 21.8 to 62.5 ) , nonbacteremic and noninvasive community-acquired pneumonia occurred in 33 persons in the PCV13 group and 60 persons in the placebo group ( vaccine efficacy , 45.0 % ; 95.2 % CI , 14.2 to 65.3 ) , and invasive pneumococcal disease occurred in 7 persons in the PCV13 group and 28 persons in the placebo group ( vaccine efficacy , 75.0 % ; 95 % CI , 41.4 to 90.8 ) . Efficacy persisted throughout the trial ( mean follow-up , 3.97 years ) . In the modified intention-to-treat analysis , similar efficacy was observed ( vaccine efficacy , 37.7 % , 41.1 % , and 75.8 % , respectively ) , and community-acquired pneumonia occurred in 747 persons in the PCV13 group and 787 persons in placebo group ( vaccine efficacy , 5.1 % ; 95 % CI , -5.1 to 14.2 ) . Numbers of serious adverse events and deaths were similar in the two groups , but there were more local reactions in the PCV13 group . CONCLUSIONS Among older adults , PCV13 was effective in preventing vaccine-type pneumococcal , bacteremic , and nonbacteremic community-acquired pneumonia and vaccine-type invasive pneumococcal disease but not in preventing community-acquired pneumonia from any cause . ( Funded by Pfizer ; CAPITA Clinical Trials.gov number NCT00744263 . ) ABSTRACT BACKGROUND Recently released results from a r and omized controlled trial have shown that 13-valent pneumococcal conjugate vaccine ( PCV13 ) is efficacious against vaccine-type nonbacteremic pneumonia in adults . OBJECTIVE We examined the incremental cost-effectiveness of adding PCV13 to the Advisory Committee on Immunization Practice s ( ACIP ) adult immunization schedule . METHODS We used a probabilistic model following cohorts of 50- , 60- , or 65-year-olds . We used separate vaccination coverage and disease incidence data for healthy and high-risk adults .  Incremental cost-effectiveness ratios were determined for each potential vaccination strategy . RESULTS In the base case scenario , our model indicated that adding PCV13 at age 65 or replacing 23-valent pneumococcal polysaccharide vaccine ( PPSV23 ) at age 65 with PCV13 provided more value for money than adding PCV13 at ages 50 or 60 . After projections of six additional years of herd protection from the childhood immunization program were incorporated , we found adding PCV13 dominated replacing PPSV23 .  For a cohort of 65-year-olds in 2013 , the cost of adding PCV13 at age 65 to the schedule was $ 62,065 per quality -adjusted life year ( QALY ) gained , which rose to $ 272,621 after 6 years of projected herd protection . CONCLUSION The addition of one dose of PCV13 for adults appears to have a cost-effectiveness ratio comparable to other vaccination interventions in the short run , though anticipated herd protection from the childhood immunization program may dramatically increase the cost per QALY after only a few years BACKGROUND We assessed the effectiveness of a 23-valent pneumococcal vaccine in the prevention of pneumococcal pneumonia and of pneumonia overall in non-immunocompromised middle-aged and elderly people . METHODS The prospect i ve , multicentre , double-blind , r and omised , placebo-controlled trial was carried out across departments of infectious diseases at six tertiary-care or university hospitals in Sweden . 691 non-immunocompromised patients aged 50 - 85 years who had been treated as in patients for community-acquired pneumonia ( CAP ) were r and omly assigned either 23-valent pneumococcal capsular polysaccharide vaccine or placebo ( sodium chloride ) . We used Cox regression models to estimate the relative risks of pneumonia overall and pneumococcal pneumonia for the placebo group compared with the vaccine group . FINDINGS 63 ( 19 % ) of 339 patients in the vaccine group and 57 ( 16 % ) of 352 patients in the placebo group developed a new pneumonia , corresponding to a relative risk over time for the placebo group compared with the vaccine group of 0.83 ( 95 % CI 0.58 - 1.12 , p=0.31 ) . Pneumococcal pneumonia was diagnosed in 16 ( 4.5 % ) patients in the placebo group and in 19 ( 5.6 % ) in the vaccine group , corresponding to a relative risk for the placebo group of 0.78 ( 95 % CI 0.40 - 1.51 , p=0.45 ) . We found no difference in the death rate between the two study groups . INTERPRETATION The 23-valent pneumococcal polysaccharide vaccine did not prevent pneumonia overall or pneumococcal pneumonia in middle-aged and elderly individuals BACKGROUND Although the protective efficacy of pneumococcal polysaccharide vaccine has been demonstrated in r and omized trials in young African gold miners , there has been controversy about its efficacy in older Americans at risk for serious pneumococcal infections . To assess the vaccine 's protective efficacy against invasive pneumococcal infections , we conducted a hospital-based case-control study of the efficacy of pneumococcal vaccine in adults with a condition recognized to be an indication for receiving the vaccine . METHODS From 1984 to 1990 , adults in whom Streptococcus pneumoniae was isolated from any normally sterile site were identified by prospect i ve surveillance in the microbiology laboratories of 11 large hospitals ; those with an indication for pneumococcal vaccine were enrolled as case patients . For each case patient , one control was matched according to age , underlying illness , and site of hospitalization . We contacted all providers of medical care to ascertain each subject 's history of immunization with pneumococcal vaccine . Isolates of S. pneumoniae were serotyped by an investigator unaware of the subject 's vaccination history . RESULTS Thirteen percent of the 1,054 case patients and 20 percent of the 1,054 matched controls had received pneumococcal vaccine ( P less than 0.001 ) . When vaccine was given in either its 14-valent or its 23-valent form , its aggregate protective efficacy ( calculated as a percentage : 1 minus the odds ratio of having been vaccinated times 100 ) against infections caused by the serotypes represented in the vaccine was 56 percent ( 95 percent confidence interval , 42 percent to 67 percent ; P less than 0.00001 ) for all 983 patients infected with a serotype represented in the vaccine , 61 percent for a subgroup of 808 immunocompetent patients ( 95 percent confidence interval , 47 percent to 72 percent ; P less than 0.00001 ) , and 21 percent for a subgroup of 175 immunocompromised patients ( 95 percent confidence interval , -55 percent to 60 percent ; P = 0.48 ) . The vaccine was not efficacious against infections caused by serotypes not represented in the vaccine ( protective efficacy , -73 percent ; 95 percent confidence interval , -263 percent to 18 percent ; P = 0.15 ) . CONCLUSIONS Polyvalent pneumococcal vaccine is efficacious in preventing invasive pneumococcal infections in immunocompetent patients with indications for its administration . This vaccine should be used more widely BACKGROUND The serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine ( PPV23 ) against pneumococcal pneumonia has not been established in people aged 65 years or older . We assessed the effectiveness of PPV23 in this population . METHODS For this multicentre , prospect i ve study , we enrolled all individuals aged 65 years or older with community-onset pneumonia who visited four study hospitals in Japan between Sept 28 , 2011 , and Aug 23 , 2014 . Streptococcus pneumoniae was isolated from sputum and blood sample s , and serotyped by the capsular Quellung method . Sputum sample s were further tested by PCR assay to identify pneumococcal DNA , and positive sample s were examined for 50 serotypes by a nanofluidic real-time PCR assay . Urine sample s were tested by a urinary antigen test . Serotype-specific vaccine effectiveness was estimated using the test-negative design . FINDINGS 2621 eligible patients visited the study hospitals , of whom 585 did not have sputum sample s available and were excluded from our analysis . 419 ( 21 % ) of 2036 patients were positive for pneumococcal infection ( 232 by sputum culture , 317 by sputum PCR , 197 by urinary antigen test , and 14 by blood culture ) . 522 ( 26 % ) patients were judged to be vaccinated in the analyses . Effectiveness of PPV23  was 27·4 % ( 95 % CI 3·2 to 45·6 ) against all pneumococcal pneumonia , 33·5 % ( 5·6 to 53·1 ) against PPV23 serotypes , and 2·0 % ( -78·9 to 46·3 ) against non-PPV23 serotypes . Although no significant differences between subgroups were seen , higher protection was noted in people younger than 75 years , women , and individuals with lobar pneumonia or health-care-associated pneumonia . INTERPRETATION PPV23 showed low to moderate effectiveness against vaccine serotype pneumococcal pneumonia in people aged 65 years or older . To improve the current pneumococcal vaccination programme , the variability of PPV23  effectiveness in different groups of older people must be further investigated . FUNDING Pfizer and Nagasaki University
Background Previous systematic review s concluded that pneumococcal vaccination  in the elderly was cost effective .
However , recently published economic evaluations state that it may not be cost effective when children are vaccinated with higher-valent pneumococcal conjugate vaccines .
The literature suggests that the outcomes of vaccination in the elderly are strongly influenced by the vaccine effectiveness ( VE ) against the vaccine-type pneumococcal diseases ( PD ) and the impact of childhood vaccination on the vaccine-type PD incidence in the elderly , but the extent remains unclear .