  Potential benefits in specific high-risk groups
for pneumococcal vaccination
People with asthma
People with COPD
People with cardiovascular disease or diabetes
Contraindications to pneumococcal vaccination
Vaccine availability
People with asthma
Very few high-quality studies have assessed the effects of pneumococcal
vaccination in reducing morbidity and mortality from pneumococcal
disease in people with asthma. A Cochrane review identified only one
randomised controlled trial designed to test the efficacy of
prophylactic sulfisoxazole and pneumococcal vaccination in reducing the
incidence of otitis media in children with asthma.27
This trial showed
some benefit in reducing asthma exacerbations in children who had
recurrent otitis media, but trial methodology was deemed poor.38 The
review concluded that the role of pneumococcal vaccination for people
with asthma is unclear, and there is not enough evidence to warrant the
recommendation of routine vaccination for all people with asthma.27 The Center for Disease Control states that, in relation to the 23vPPV
vaccine, asthma is not an indication for routine pneumococcal
vaccination unless it occurs with chronic bronchitis, emphysema, or
long-term systemic corticosteroid use.39
However, a case-control study found that asthma is an independent risk
factor for invasive pneumococcal disease.46
The study found that there was at least a two-fold higher risk of
developing invasive pneumococcal disease in people with asthma, independent of
long-term corticosteroid use and other obstructive lung disease,
compared to the control group.46
Australian recommendations
Pneumococcal vaccination
guidelines for Australians recommend the 23vPPV
vaccination for older Australians and high-risk
groups, and the 7vPPV for children. The
guidelines do not include asthma as a high-risk
disease requiring routine immunisation.40
Implications for Australian
practice
|
People with COPD
People with COPD are at risk of pneumococcal pneumoniae and its
complications.41 Pneumococcal vaccination has been shown to reduce the
incidence of invasive pneumococcal disease in older people, including
those with chronic conditions,4 but few studies have specifically
investigated the efficacy of pneumococcal vaccination in adults with
COPD.
A retrospective cohort study found that pneumococcal vaccination was
associated with a lower risk of death or hospitalisation due to
pneumonia in people with chronic lung disease.42 In this study, the
benefits of pneumococcal and influenza vaccinations were additive in
this patient population, with a significantly lower rate of
hospitalisation for pneumonia and influenza in those who received both
vaccinations compared to those who received neither. An earlier
meta-analysis of randomised controlled trials found that pneumococcal
vaccination was less efficacious in high-risk patients, including those
with chronic medical conditions, compared to low-risk adults.34
Overall, pneumococcal vaccination has been shown to reduce the incidence
of pneumonia in the elderly and is likely to be beneficial in COPD
patients who have an increased risk of pneumonia.7,43
Australian recommendations
The Australian Immunisation
Handbook1 recommends 23vPPV
vaccination for immunocompetent persons aged 5
years and older who are at risk of IPD due to
chronic illness, including chronic lung disease.
COPDX guidelines7 state that:
“Pneumococcal vaccination is known to be highly
effective in preventing invasive bacteraemic
pneumococcal pneumonia, but may be less
effective in elderly or immunosuppressed
patients. There is no direct evidence of its
efficacy in preventing pneumococcal
exacerbations of COPD, but prevention of
pneumonia in these patients with already reduced
respiratory reserve is a worthy goal in its own
right, so pneumococcal vaccination (polyvalent
covering 23 virulent serotypes) is recommended.”7
Implications for Australian
practice
|
People with cardiovascular disease or diabetes
People with diabetes are susceptible to pneumococcal infection and are at
increased risk of morbidity and mortality from bacteremia.44 Chronic
cardiovascular disease is also associated with a higher risk of
pneumococcal infection.1
Few studies have assessed the effects of pneumococcal vaccination in
people with cardiovascular disease or diabetes. Pneumococcal vaccination
has been shown to be efficacious in some high-risk groups, including
those with diabetes and cardiovascular disease, and is currently
recommended to reduce the risk of invasive disease in these groups.45
Australian recommendations
The Australian Immunisation
Handbook1 recommends 23vPPV
vaccination for immunocompetent persons aged 5
years and older who are at risk of IPD due to
chronic illness, including chronic cardiac
disease and diabetes. Children who are at
increased risk of IPD, including those with
diabetes or cardiac disease associated with
cyanosis or cardiac failure, should receive a
fourth booster dose of 7vPCV at 12 months of age
and a booster dose of 23vPPV at 4-5 years of
age. This is because these children may have a
lower immune response to the 7vPCV and have a
continued risk of developing IPD.1
Implications for Australian
practice
-
Patients aged over 5
years with diabetes or chronic cardiac
disease should receive pneumococcal
vaccination
-
Children at increased
risk of IPD, including those with
diabetes or cardiac diseases associated
with cyanosis or cardiac failure, should
receive a fourth booster dose of 7vPCV
at 12 months of age and a booster dose
of 23vPPV at 4-5 years of age
These recommendations are
supported by the National Heart Foundation
of Australia. |
Contraindications to pneumococcal
vaccination1
-
Serious allergic reaction to the
vaccination after an earlier dose.
-
Serious allergy to any of the
vaccine ingredients.
-
Recent treatment that suppresses
the immune system, or radiation therapy to the
lymph nodes. These patients can have the
vaccination once their immune systems have
recovered.
Vaccine availability
-
Both the influenza and adult
pneumococcal vaccines (23vPPV) are available
free for persons aged 65 years and older, as
part of the Commonwealth Government's funded
vaccination program.
-
Both vaccines are also available
free for Indigenous Australians and Torres
Strait Islanders aged 50 years and older, and
for those aged less than 50 with co-morbidities.
-
The 7vPCV pneumococcal vaccine
is free for children as part of the Commonwealth
Government's Childhood Immunisation Schedule.
-
Influenza and adult pneumococcal
vaccines are also available on the PBS for
people at high risk, including people with
chronic respiratory diseases, diabetes and
cardiovascular disease.
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