Research shows impact of PNEUMOVAX23 in adults over 65

9 minute read

Immunology

By

Sponsored

GPs urged to drive pneumococcal vaccine uptake in adults 65 years and above [SPONSORED]

New research highlights the evolving epidemiological trends in adult pneumococcal disease in Australia.1

The herd immunity impact of the successful infant pneumococcal conjugate vaccine (PCV) programs has helped protect older adults against invasive pneumococcal disease (IPD) caused by the specific PCV serotypes. However, the burden of IPD caused by non-PCV serotypes has increased, reflecting a phenomenon known as ‘serotype replacement’.1

This latest epidemiological research presented at the International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) conference in Melbourne this week demonstrates the funded adult 23-valent pneumococcal polysaccharide vaccine (23vPPV), PNEUMOVAX®23 program, is having a significant impact on IPD, with notifications attributable to the 11 serotypes unique to PNEUMOVAX®23 increasing at a significantly lower rate compared with those due to non-vaccine serotypes in adults aged 65 years and over.1

Australia’s adult pneumococcal vaccination program has delivered this public health benefit despite sub-optimal coverage rates, estimated to be around 50 per cent for eligible adults aged 65 years and over, who are considered at risk of IPD.2-3 All GPs can help protect this vulnerable population by proactively checking their patients’ vaccination status and recommending PNEUMOVAX®23, which is the only adult pneumococcal vaccine available on the National Immunisation Program (NIP),4 to all eligible adults who may be otherwise missing out.

According to Professor Allan Cripps AO, Research Professor, School of Medicine, Griffith University, there is a substantial burden of disease associated with IPD in adults aged 65 years and over, with mortality rates of up to 16 per cent and over 78,000 pneumonia related GP visits in this age group annually.5

“Older Australians are at a higher risk of pneumococcal pneumonia,6 so the availability of a pneumococcal vaccine on the NIP can help reduce the incidence of IPD and may also reduce the incidence of pneumonia in this population.”

The changing epidemiology of IPD in Australia,1 as well as the associated impact of morbidity, mortality and health care costs of IPD,5-7 highlights the need to continue to be proactive in helping protect vulnerable adult Australians. While coverage of the infant vaccination program has averaged 93 per cent across all States and Territories in Australia,8 uptake of the adult 23vPPV remains suboptimal, at 54 per cent national coverage in 2009,2 and less than 50 per cent in 2015-2016, based on a New South Wales health survey.3 This reflects a large gap in coverage between funded infant and adult vaccination programs.9

Associate Professor John Litt, Discipline of General Practice, Flinders University, Adelaide stresses the crucial role of GPs in improving vaccine uptake.

“By ensuring patients aged 65 years and above are made aware of their increased risk of IPD and strongly encouraging vaccination against pneumococcal disease, GPs play a vital role in helping to reduce the burden of IPD.”

In order to understand the impact of both the infant and adult vaccination programs on the incidence of IPD in adults aged 65 years and over, the researchers examined the serotype-specific effects on adult IPD notifications, caused by the various vaccine serotype groups.1

Using data on ~8,000 IPD notifications in patients aged 65 years and older accrued between 2002 and 2016, the researchers showed that since 2005, when infant immunisation with the 7vPCV was introduced in Australia, there has been a marked decline in reports of IPD caused by these 7 serotypes.1 After 2011 when the 7vPCV was replaced with the 13vPCV, IPD due to the additional serotypes in 13vPCV also declined in adults, demonstrating the benefits of herd immunity of the infant vaccination program.1

Conversely, IPD due to non-PCV serotypes increased significantly, due to the impact of serotype replacement. However, incidence rates of IPD due to the 11 unique serotypes in the adult 23vPPV only doubled from 2005 to 2016, compared to a substantial 8-fold increase in IPD due to non-vaccine serotypes over the same time period. This striking difference is thought to reflect the impact of the inclusion of the 23vPPV on the NIP for adults aged 65 years and older, which commenced in 2005.1 This impact is observed despite the current sub-optimal levels of vaccine uptake in adults aged 65 years and above,3 highlighting the potential benefit of increasing adult 23vPPV coverage.

About invasive pneumococcal disease (IPD) & National Immunisation Program

The bacterium Streptococcus pneumoniae is the causative agent of pneumococcal diseases, which can range from mild infections, such as sinusitis and otitis media, to fatal diseases such as meningitis, septicaemia and pneumonia. IPD is defined as pneumococcal infection confirmed by isolation of S. pneumoniae from a normally sterile site,10 and is associated with significant morbidity and mortality worldwide.8

On average, 72 per cent of IPD in adults aged 65 years and older tends to be pneumonia, with a case fatality rate of up to 16 per cent. The costs associated with pneumococcal pneumonia, including hospitalisations and GP visits, has been estimated to be upwards of $58.5 million per annum.6

In 2001, IPD was included as a notifiable disease under the National Notifiable Surveillance System (NNDSS).12 In 2005, Australia introduced universal infant immunisation with the 7-valent pneumococcal conjugate vaccine (7vPCV),11 which was replaced in 2011 with the 13-valent pneumococcal conjugate vaccine (13vPCV).6 Also in 2005, the 23-valent pneumococcal polysaccharide vaccine, PNEUMOVAX®23 was included on the NIP for all adults 65 years and above.11

The infant pneumococcal vaccination program includes the 13vPCV, which is covered under the NIP. In addition, the NIP covers the 23vPPV for children aged 4 years and above with medical conditions that predispose to IPD, and for all adults aged 65 and older.4 Adults under 65 years of age with conditions associated with an increased risk of pneumococcal infection such as chronic cardiac disease, severe asthma, diabetes mellitus, haemoglobinopathies, spleen dysfunction, and those on immunosuppressive therapies, are recommended to receive a dose of 23vPPV, which is funded under the PBS.13

Serotype replacement is a phenomenon where increases in the proportion of pneumococcal disease caused by non-vaccine serotypes occurs following the introduction of vaccination programs. It has been shown in other countries to play a role in shaping the epidemiology of IPD and has the potential to diminish the public health benefits of vaccination, should it remain unchecked.14

PBS Information: This product is listed on the National Immunisation Program (NIP) Schedule and the PBS. Refer to the NIP and PBS Schedule.

 Before prescribing, please review Product Information available at http://www.seqirus.com.au/PI.

 MINIMUM PRODUCT INFORMATION.

PNEUMOVAX®23 (Pneumococcal vaccine, polyvalent). Purified capsular polysaccharides from 23 pneumococcal types. INDICATIONS: Immunisation against pneumococcal disease of the specified capsular types in all persons over 65 years; Aboriginal and Torres Strait Islander people over 50 years; individuals over age 2 with asplenia; immunocompromised patients at increased risk of pneumococcal disease; immunocompetent persons at increased risk of complications from pneumococcal disease; patients with cerebrospinal fluid (CSF) leaks; tobacco smokers. CONTRAINDICATIONS: Hypersensitivity to any component of the vaccine. PRECAUTIONS: Immunocompromised Patients: Chemotherapy or immunosuppressive therapy (e.g. in Hodgkin’s disease); continue proven antibiotic prophylaxis against pneumococcal infection after vaccination. General: Intradermal administration may cause severe local reactions. May not be effective in preventing meningitis in patients with chronic CSF leakage. Exercise care with individuals with severely compromised cardiac and/or pulmonary function; consider delaying vaccination in febrile respiratory illness or active infection. Paediatric Use: Not recommended in children aged under 2; Pregnancy: Category B2. Lactation: Caution in nursing mothers. ADVERSE EFFECTS: Most commonly, fever and injection site reactions including soreness, erythema, warmth, swelling and local induration. Compared with primary vaccination, an increased rate of local reactions has been observed with revaccination at 3–5 years following primary vaccination. Cellulitis-like reactions have been reported in post-marketing experience. DOSAGE AND ADMINISTRATION: 0.5mL subcutaneously or intramuscularly only. Do not inject intravenously. Intradermal administration should be avoided. Give two weeks before elective splenectomy, commencement of cancer chemotherapy, or immunosuppressive therapy. Avoid vaccination during chemotherapy or radiation therapy. Revaccination is recommended in some at risk individuals; consult the Australian Immunisation Handbook regarding revaccination. Based on approved Product Information: 09 March 2017.

References:  

  1. Stein A, Cripps AW, Litt J, Menzies R. (April, 2018). Epidemiology of Invasive Pneumococcal Disease in Older Australians Reflects Impact of Childhood and Adult Pneumococcal Vaccinations Programs. 11th International Symposium on Pneumococci and Pneumococcal Diseases, Melbourne, Australia.
  2. Australian Government (2011). 2009 Adult Vaccination Survey: Summary results. Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/getmedia/91c13f90-7a4f-44ff-b09d-bcf344f7ca6d/11936.pdf.aspx?inline=true.
  3. HealthStats NSW. (2017) Influenza and pneumococcal disease immunisation; by age and year. Available at: http://www.healthstats.nsw.gov.au/Indicator/com_flupneumoimmu_age/com_flupneumoimmu_age_snap.
  4. Australian Government, Department of Health. National Immunisation Program Schedule. Available at: https://beta.health.gov.au/topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule.
  5. Earle K, Williams S (2016) Burden of pneumococcal disease in adults aged 65 years and older: an Australian perspective. 8:9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471924/pdf/41479_2016_Article_8.pdf.
  6. The Australian Immunisation Handbook, 10th Edition. 2013. Available at: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10home~handbook10part4~handbook10-4-13.
  7. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases and Australian Institute of Health and Welfare. (2010) Vaccine Preventable Diseases in Australia, 2005 to 2007. Communicable Diseases Intelligence. (34) Supplement. Available at: http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdi34suppl.htm~cda-cdi34suppl-3-vpd.htm~cda-cdi34suppl-3-vpd10.htm.
  8. National Centre for Immunisation Research and Surveillance. (2015). Adult Immunisation Coverage Report 2015. Available at: http://www.ncirs.edu.au/assets/surveillance/coverage/Annual-Immunisation-Coverage-Report-2015.pdf.
  9. Menzies R, Leask J, Royle J, MacIntyre R (2017). Vaccine Myopia: adult vaccination also needs attention. Med J Aust. 206(6): 238-239. Available at: https://www.mja.com.au/journal/2017/206/6/vaccine-myopia-adult-vaccination-also-needs-attention.
  10. Invasive Pneumococcal Disease (IPD) (Streptococcus pneumoniae) 2017 case definition. Available at: https://wwwn.cdc.gov/nndss/conditions/invasive-pneumococcal-disease/case-definition/2017/.
  11. Roche P, Krause V, Cook H et al. (2005) Annual Report: Invasive Pneumococcal Disease in Australia, 2005. https://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3101-pdf-cnt.htm/$FILE/cdi3101d.pdf.
  12. Australian Government. (2018) Invasive Pneumococcal Disease Surveillance: IPD Public Data Set: Australian national notifiable diseases by disease type. Department of Health. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-ipd-reports.htm.
  13. Australian Government, Department of Health. The Pharmaceutical Benefits Scheme. Available at: http://www.pbs.gov.au.
  14. Weinberger DM, Malley R, Lipsitch M. (2011) Serotype replacement in disease after pneumococcal vaccination. Lancet 2011; 378: 1962–73. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)62225-8.pdf.

End of content

No more pages to load

Log In Register ×