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Should adults get the pediatric pneumococcal vaccine?

MONTREAL -- IS there a role for giving the children's conjugate vaccine to adults, asked Dr. Keith Klugman at an international conference on community-acquired pneumonia.

A recent study suggested that it may not be as simple as that (Vaccine 2007;25:4029-37). Immunogenicity among elderly patients (aged 7079 years) who were given the children's dose of conjugate vaccine was "nothing to get overly excited about," said Dr. Klugman, a professor of infectious diseases and the William H. Foege Chair of Global Health at Emory University in Atlanta.

"Perhaps the dose designed for a primary response in kids is not enough for adults," he suggested.

And a study presented at the 2006 International Symposium on Pneumococci and Pneumococcal Diseases by Dr. Andres de Roux, of the Universitat Autonoma de Barcelona, and colleagues suggested that the administration of the children's conjugate vaccine to elderly patients within i year of giving them the polysaccharide vaccine could actually suppress immunity.

"It seems the adult vaccine interferes with the response to the conjugate, which is a concern, because it means we can't simply give the conjugate to people who have previously had the [23-valent pneumococcal polysaccharide vaccine (PPV 23)]. There will have to be a strategy, and it seems that certainly the conjugate needs to be given before the 23-valent," Dr. Klugman said.

Dr. Klugman said that in his opinion, a new conjugate vaccine, with coverage of more strains than the current one, will eventually replace the PPV 23 for adults.

Data from the Centers for Disease Control and Prevention show that adult infections with the seven pneumococcal strains covered in the children's vaccine have decreased, while infections from the other 16 strains covered by the adult vaccine have increased.

"The burden of disease in adults has been impacted more by giving the conjugate vaccine to children than by giving the 23-valent vaccine to adults," said Dr. Klugman.

A new study (Lancet 2007;369:1179-86) offers evidence that vaccinating children protects adults against all pneumococcal pneumonia, not just bacteremic pneumococcal pneumonia, he said at the conference, sponsored by the International Society of Chemotherapy.

Improving pneumococcal vaccine coverage in children could result in dramatic reductions in infection across all ages, he said.


Montreal Bureau

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Title Annotation:Infectious Diseases
Comment:Should adults get the pediatric pneumococcal vaccine?(Infectious Diseases)
Author:Johnson, Kate
Publication:Family Practice News
Geographic Code:1USA
Date:May 15, 2007
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