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DH advisers mull change to pneumococcal vaccination in over-65s

Department of Health advisers are considering changes to the schedule for pneumococcal vaccination in the wake of a new study that questions its use in all patients aged over 65.

Researchers at the Health Protection Agency said existing evidence favoured a more ‘targeted approach’ in older people.

A review by the Joint Committee on Vaccination and Immunisation last year concluded the vaccination programme in older patients had ‘no discernable impact’ on rates of pneumococcal disease.

But this recommendation was later withdrawn by the JCVI after data from the HPA showed a general practice-led risk group-based system was unlikely to be cost-effective.

The full data from the HPA has now been published, and the researchers conclude it backs a risk-based approach. Pulse understands the JCVI will consider the implications of the paper at a meeting next week.

The HPA looked at records of over 22,000 patients with invasive pneumococcal disease and compared them to the general population.

They found an increased rate of invasive pneumococcal disease in older patients, with an overall incidence per 100,000 in 2009/10 of 4.8 in two to 15 year olds, 8.3 in 16 to 64 year olds and 56.7 in those aged 65 or older.

But the risk of hospitalisation and death due to pneumococcal disease reduced with age.

Those aged two to 15 years had nearly a 12-fold risk of hospitalisation from pneumococcal disease, and a risk of death of 2.4, compared with the general populations. Those aged 16 to 24 had odds of 7.6 and 3.9, respectively, and this fell to 2.4 and 1.2 for those aged 65 years or older.

The most important risk factors that predicted invasive pneumococcal disease were chronic liver disease, immunosuppression, and chronic respiratory diseases.

Study leader Dr Albert Jan van Hoek, an infectious disease modeller at the HPA said their data proved that vaccination in at-risk groups was crucial.

He said: ‘It provides an evidence base for the targeted vaccination approach with PPV23 adopted by many countries, or if an age based vaccination approach is adopted, that evaluating the coverage among risk groups is key.’

Dr George Kassianos, RCGP immunisation lead and a GP in Bracknell, Berkshire, said it was still valid to vaccinate all over-65s.

He said: ‘There is no question about the benefit of pneumococcal immunisation in those with underlying clinical conditions of any age, but this does not mean it is not worth immunising the over 65s.’

‘The case fatality rate from pneumococcal bacteraemia is 20% in the general population, but among the elderly it is 60%.

‘We should immunise against pneumococcal infection patients with underlying medical conditions of any age but we must also immunise the over 65s as they are more vulnerable.’


Reduced risk with age

Age group Risk of hospitalisation from IPD Risk of death from IPD
2-15 years 11.7 2.4
16-64 7.6 3.9
65 + 2.4 1.2


Source: Journal of Infection 2012; 65: 17-24