Authors: M.J.M. Bonten, S.M. Huijts, M. Bolkenbaas, C. Webber, S. Patterson, S. Gault, C.H. van Werkhoven, A.M.M. van Deursen, E.A.M. Sanders, T.J.M. Verheij, M. Patton, A. McDonough, A. Moradoghli‑Haftvani, H. Smith, T. Mellelieu, M.W. Pride, G. Crowther, B. Schmoele‑Thoma, D.A. Scott, K.U. Jansen, R. Lobatto, B. Oosterman, N. Visser, E. Caspers, A. Smorenburg, E.A. Emini, W.C. Gruber, and D.E. Grobbee

Summary

Streptococcus pneumoniae, a major cause of community-acquired pneumonia in the elderly, results in considerable morbidity and mortality. Pneumococcal community-acquired pneumonia most commonly presents as non bacteremic disease. Invasive pneumococcal disease, which involves infection of normally sterile sites, occurs in approximately 25% of cases. Immunologic protection against pneumococcal disease is mediated through opsonophagocytic antibodies directed against bacterial capsular polysaccharides that define the pneumococcal serotypes and serve as virulence factors.
The efficacy of pneumococcal conjugate vaccines for the prevention of vaccine-type invasive and noninvasive community-acquired pneumonia in adults 65 years of age or older has not been determined. The assessment of efficacy became possible with the development of a serotype-specific urinary antigen detection assay. Using this assay, the authors were able to evaluate a 13-valent pneumococcal conjugate vaccine (PCV13) for the prevention of vaccine-type invasive and noninvasive community-acquired pneumonia in adults 65 years of age or older.
This was a parallel-group, randomized, placebo-controlled, double-blind trial. In this study, was found that PCV13 had significant efficacy for the prevention of vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease among adults 65 years of age or older, and the efficacy persisted for at least 4 years. In the per-protocol population, vaccine efficacy was 46% for the prevention of a first episode of vaccine-type community acquired pneumonia, 45% for the prevention of nonbacteremic and noninvasive vaccine-type community-acquired pneumonia, and 75% for the prevention of vaccine-type invasive pneumococcal disease. PCV13 was not effective in preventing community-acquired pneumonia from any cause.

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