Regional advisory board position statement on optimal pneumococcal vaccination in adults. Update to 2011 consensus on adult pneumococcal disease: update on optimal pneumococcal vaccination in adults.

SUMMARYBackground: An important development in the field of adult pneumococcal vaccination since the last Consensus Statement, published by the Expert Panel of Central and Eastern Europe and Israel (the Region) in September 2012, was the licensure of the 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged 50 years and older.Discussion: The Expert Panel has developed this Position Statement as an update to its previous Consensus to address the following topics which are likely to be on the agenda of national scientific societies during the ongoing updates of vaccination recommendations in the Region: the availability of a pneumococcal conjugate vaccine for adults over 50 years of age, the available clinical evidence on its use in adults, and the future place of conjugate vaccines in adult pneumococcal vaccination. The Expert Panel concluded that there is sufficient epidemiologic immunogenicity and safety evidence to use PCV 13 in adults over 50 years of age.Results: The use of conjugate vaccine induces immunological memory and can overcome some limitations associated with the plain polysaccharide vaccine (PPV). It was also agreed that, if the use of PPV is considered appropriate, PCV13 should be administered first, regardless of prior pneumococcal vaccination status.Key words: invasive pneumococcal disease (IPD), community-acquired pneumonia (CAP), Central and Eastern Europe (CEE), Israel, pneumococcal vaccines, vaccination, elderly adultsBACKGROUNDDespite advances in prevention and medical management, S. pneumoniae infections continue to exert a significant burden on the adult population (1). Further, incidence and mortality of pneumococcal disease in adults start to rise at 50 years of age and reach a second peak among older adults that may exceed the significant disease burden recognized in children less than 5 years of age (2). Incidence of pneumococcal disease is currently underestimated, as bacteriological laboratory confirmation methods are underused and have limitations in their diagnostic yield. The definition of invasive pneumococcal disease (IPD) is ambiguous and varies in different sources since there is no consensus about whether laboratory methods beyond conventional bacteriological culture should be considered, e.g. PCR, BinaxNOW, etc. Further, limitations of the culture based bacteriology laboratory methods, together with the usually occurring previous antibiotic treatment, make it difficult to detect bacteremia in pneumonia cases and, therefore, to differentiate between bacteremic (invasive) and non-bacteremic (non-invasive) pneumococcal pneumonia. This is an important consideration since pneumococcal disease in adults presents most often as pneumonia.Significant antibiotic resistance of S. pneumoniae in many countries of the Region suggests that there is a need for further optimization of prevention. In the majority of countries within the Region, pneumococcal vaccination in adults has been very limited due to low awareness among primary care professionals and the public, who tend to associate vaccination with children only. Additionally there is often a general, overriding negative connotation associated with vaccination. Data from randomized clinical trials and meta-analyses of studies evaluating the use of the plain polysaccharide vaccine (PPV) in adults have demonstrated a moderate decline of IPD incidence but little or no effect against pneumonia (3,4). Repeat doses of PPV are generally not recommended for healthy adults by most of the guidelines, reflecting its limitations in providing protection through the long adult age period (3,4), but may be suggested for specific circumstances in some countries (5). Pneumococcal conjugate vaccines (PCV) have led to significant reductions in disease burden in children, particularly where the vaccine has been incorporated into child vaccination programmes (CVP). Significant reductions in isolation of S. …