Search

The pneumococcal polysaccharide vaccine may be more effective in certain patient populations than in others. The pneumococcal vaccine is given to at-risk individuals to prevent community-acquired pneumonia and meningitis. Researchers examined the the effectiveness of the vaccine in 2,837 patients over five years old with an infection of the blood or cerebrospinal fluid between May 1978 and Apr 1992. The vaccine was 57% effective in preventing infections caused by the serotypes of Streptococcus pneumoniae included in the vaccine. It was 84% effective for patients with diabetes mellitus, 73% for those with coronary vascular disease, 69% for those congestive heart failure and 65% for those with chronic pulmonary diseases. The time since vaccination did not affect efficacy of the vaccine significantly.

The article discusses the updated recommendations prevention of invasive pneumococcal disease among adults by the Advisory Committee on Immunization Practices (ACIP) through the use of the 23-valent pneumococcal polysaccharide vaccine (PPSV23). The changes in the recommendations for the use of PPSV23 are highlighted.

While pneumococcal pneumonia causes much illness and death among the elderly, vaccination against the disease is not widely practiced. This is true in spite of the known effectiveness of vaccination for high-risk and elderly patients, most of whom have additional medical problems. Since many people who are hospitalized due to pneumococcal bacteremia (a systemic infection with the pneumococcus organism) have been previously discharged from a hospital within the preceding three to five years, it is possible that immunization at the time of hospital discharge could reduce the incidence of subsequent pneumococcal pneumonia. This was examined in an epidemiological study of hospital discharges of Medicare patients in the Shenandoah, Virginia area. Results showed that 11.1 percent of the 1,633 people aged 65 or over discharged from Shenandoah hospitals with pneumonia had a diagnosis of pneumococcal pneumonia. Approximately 61 percent of the whole group had been discharged from a Shenandoah hospital at least once within the previous four years, most often within the previous two years. Eighty-seven percent of these patients had at least one high-risk condition. The probability of hospital admission with pneumonia for a cohort of patients discharged from Shenandoah hospitals without a diagnosis of pneumonia was between 6 and 9 percent (depending on patients' ages) over a five-year period. Calculations of the probable effect of immunization against pneumococcal pneumonia showed that 100 or fewer discharged patients would need to be vaccinated to prevent one pneumonia readmission. Pneumococcal vaccination of elderly people is inexpensive compared with the cost of hospitalization for pneumonia, and the results provide epidemiologic support for a program of hospital-based pneumococcal immunization. (Consumer Summary produced by Reliance Medical Information, Inc.)

An educational handout written at the fifth grade level or lower may be effective in encouraging elderly patients to get vaccinated against Streptococcus pneumoniae. The pneumococcal vaccine can protect against pneumonia caused by this bacterium. Researchers randomly gave 433 elderly poor patients an educational handout about pneumococcal vaccine or nutrition. Those who received the educational handout were four times more likely to discuss the vaccine with their doctor and five times more likely to receive it compared to those who received nutritional information.

Advisers to the U.S. Centers for Disease Control and Prevention (CDC) have recommended that all smokers should receive the pneumococcal vaccine. No safety problems with the vaccine have been identified but safety monitoring of the vaccine will continue.

The number of elderly Americans who are vaccinated against influenza and pneumococcal infections is the highest ever recorded. In 1995, a survey of 22,639 adults 65 years or older found that 36% had received the pneumococcal vaccine and 58% had received the influenza vaccine during the past 12 months. This represents a 7 percentage point increase in the use of both vaccines since a similar 1993 survey. In twenty-three states, influenza vaccination rates equalled 60% or more, up from 5 states in 1993. Non-Hispanic whites were more likely to be vaccinated than blacks or Hispanics.

An analysis of 1995 Medicare billing data reveals that physicians are missing many opportunities to vaccinate elderly hospital patients against influenza and pneumococcal infections. Among 4,548 elderly patients hospitalized in 12 Western states that year, only 20% had received the pneumococcal vaccine at some time in the previous five years. About two-thirds of those not vaccinated had risk factors for pneumococcal infection. In a survey of 1,242 patients admitted to a hospital in last quarter of 1994, only 35% had received the influenza vaccine.

All nursing home residents 65 years or older should receive pneumococcal vaccine to prevent infection with Streptococcus pneumoniae. This bacterium is a common cause of pneumonia in elderly nursing home residents. In Oct, 1995, 10 people in a Massachusetts nursing home developed pneumococcal pneumonia and 2 died. In Feb, 1996, 12 people at a Oklahoma facility contracted this infection and 3 died. In May-Jun, 1996, 14 people in a Maryland facility developed pneumococcal pneumonia and 4 died. Less than 5% of the residents at these facilities had been vaccinated.

A concerted public awareness campaign can increase rates of vaccination against Streptococcus pneumoniae in the elderly. This bacterium, often called pneumococcus, is responsible for many cases of bacterial pneumonia and kills approximately 40,000 people each year in the US. The 1993 National Health Interview Survey found that fewer than 30% of high-risk people had received the pneumococcal vaccine. A Texas health care alliance found it could substantially increase the number of elderly who were vaccinated by providing its member organizations with media kits and access to lists of member hospitals offering the vaccine. Barriers to vaccination include inadequate supplies of vaccine, missed opportunities to vaccinate during physician visits and substandard vaccine delivery systems in non-health care settings such as workplaces. One of the goals of Healthy People 2000 is to increase the percentage of vaccinated elderly to 60%.

Even though a vaccine against Streptococcus pneumoniae (the organism responsible for most cases of pneumonia that require hospitalization) is available, only 10 percent of the elderly and other high-risk groups actually get immunized. Pneumococcal vaccine is utilized less than vaccines against other diseases, such as influenza, but similar factors cause the overall low utilization of adult vaccines. These factors include a lack of emphasis on preventive care in the medical community, uncertainty regarding which patients are high-risk and should be vaccinated, and fear of side effects. Why is pneumococcal vaccine particularly underutilized? The disease is difficult to diagnose; in fact, the causative organism in one-third of all cases of pneumonia is never determined. Since only one-third of pneumonias are pneumococcal, even a vaccine with good effectiveness (60 to 70 percent) will appear to 'work' for only 20 percent of the patients who undergo immunization (the remainder will not have this type of pneumonia). Attempts to convince physicians of the value of pneumococcal vaccination have not been particularly successful, nor has patient education. Another approach is described in an article in the September 5, 1990, issue of The Journal of the American Medical Association. The authors propose the immunization of high-risk people at the time they are discharged from the hospital after treatment for other disorders. Although it is impossible to calculate the benefits of such a hospital-based immunization policy directly, an estimated one-half to three-quarters of discharged, eligible patients can be immunized in this fashion. The article presents a convincing cost-benefit analysis of the savings that accrue by preventing pneumococcal pneumonia; however, such arguments are not likely to be as compelling for hospitals (needing admissions) as for health maintenance organizations (needing to keep patients out of the hospital). Financial incentives could be provided to hospitals to encourage them to immunize discharged patients. It is time for medical practice to reflect the recommendations of public health policy regarding pneumococcal pneumonia vaccination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Re-vaccinating adults with the pneumococcal polysaccharide vaccine appears to be safe. This vaccine is used to protect people from infection with Streptococcus pneumoniae. Elderly people in particular are at high risk of this infection. However, after vaccination, blood levels of protective antibodies decline over time, prompting some doctors to re-vaccinate people. A 1999 study found that people who were re-vaccinated were more likely to develop a reaction at the injection site compared to those being vaccinated for the first time. However, the reaction was minor and did not last long.