- •Pneumococcal pneumonia represents a significant disease burden in adults.
- •Awareness of pneumococcal vaccination is low among patients and vaccinators.
- •Identifying eligible patients for vaccination is critical.
- World Health Organization
- The European Centre for Disease Prevention and Control
- The Kings Fund
- Khoie T.
- Tiernan R.
- deVore N.
- NHS England
- Public Health England
2. Burden of cap in adults
- The European Centre for Disease Prevention and Control
- Rodrigues F.
- Foster D.
- Caramelo F.
- et al.
3. Benefits of vaccines for the prevention of pneumonia
- European Respiratory Society (ERS)
4. Identifying eligible patients to improve vaccination uptake
- National Immunization Survey-Flu (NIS-Flu)
- Behavioral Risk Factor Surveillance System (BRFSS)
- Torres A.
- Blasi F.
- Dartois N.
- et al.
- Mitteilung der Ständigen Impfkommission am Robert Koch-Institut (RKI)
- Bedeschi E.
- Haut Conseil de la Sante Publique
- Department of Health
|At risk||High risk|
|Metabolic diseases (diabetes mellitus)||Immunodeficiency (B or T cell deficiency)|
|Chronic respiratory disease|
(asthma, COPD, interstitial lung diseases)
|Cerebrospinal fluid leakage, skull fracture, cochlear implant|
|Chronic heart, liver, renal diseases||Functional asplenia or splenectomy|
|Chronic alcoholism||Sickle-cell anaemia|
|Patients living within an institution||Transplantation (organ or bone marrow)|
|People with a history of (pneumococcal)|
|Leukaemia, lymphoma, multiple myeloma|
- •Age over 65
- •Current or past smoker
- •High alcohol intake
- •Under- or overweight
- •Living or working in institutions such as schools, hospitals, prisons or care homes
- •Comorbidities such as diabetes, asthma or COPD
- •Previous pneumococcal infection
- •Chronic immunosuppressive disease
5. Learning points
- •Pneumonia is a vaccine-preventable disease and PCV13 has been shown to be effective in preventing vaccine-type pneumococcal non IPD CAP and IPD in older adults [].
- •Lifestyle changes could help to lower the risk of CAP [].
- •PCV13 should be given to all people diagnosed with CAP on discharge from hospital or resolution of infection in order to prevent further episodes [40,71].
- •Age-based recommendations are needed for PCV13 vaccination.
Conflicts of interest
- •Francesco Blasi has received in the last three years speaker or consultant honoraria or research funding from: Almirall, AstraZeneca, Boeringher Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Lab. Guidotti e Malesci, Menarini, Mundipharma, Novartis, Pfizer, Teva,Valeas and Zambon.
- •Murat Akova has received in the last three years speaker or consultant honoraria or research funding from: Astellas, Gilead, MSD, Pfizer, Sanofi Pasteur.
- •Paolo Bonanni has received in the last three years speaker or consultant honoraria or research funding from: Pfizer, GSK, Novartis Vaccines, Sanofi Pasteur MSD, Sequiros.
- •Nathalie Dartois is a Pfizer employee, and holds stock in Pfizer.
- •Evelyne Sauty is a Pfizer employee, and holds stock in Pfizer.
- •Chris Webber is a Pfizer employee, and holds stock in Pfizer.
- •Antoni Torres received in the last three years speaker or consultant honoraria or research funding from Astra-Zeneca, Bayer, Cardeas, GlaxoSmithKline, Pfizer and Roche.
- Atkinson W. Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Public Health Foundation, Washington, DC2012: 233-248 (second printing)
- Clinical and economic burden of community-acquired pneumonia among adults in Europe.Thorax. 2012; 67: 71-79
- Managing community-acquired pneumonia: a European perspective.Respir Med. 2007; 101: 1864-1873
- Microbial aetiology of community-acquired pneumonia and its relation to severity.Thorax. 2011; 66: 340-346
- The top 10 causes of death in the world, 2000 and 2012.(Available at:)[Accessed November 2015])Date: May 2014
- Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the global burden of disease study 2013.Lancet. 2015; 385: 117-171
- Global and regional mortality from 235 causes for death of 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010.Lancet. 2012; 380: 2095-2128
- Pneumococcal infection in adults: burden of disease.Clin Microbiol Infect. 2014; 20: 45-51
- Surveillance report 2014.
- Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study.Lancet Infect Dis. 2015; 15: 629
- Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia.Eur Respir J. 2015; 45: 1632-1641
- Prevention of adult pneumococcal pneumonia with the 13-valent pneumococcal conjugate vaccine: CAPiTA, the community-acquired pneumonia immunization trial in adults.Hum Vaccin Immunother. 2015; 11: 1825-1827
- Making our health and care systems fit for an ageing population.http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/making-health-care-systems-fit-ageing-population-oliver-foot-humphries-mar14.pdf
- Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward.Infect Chemother. 2013; 45: 351-366
- CHMP variation assessment report type II variation EMEA/H/C/001104/II/0028.in: EMA/858655/2011. European Medicines Agency, London, United Kingdom2011
- FDA briefing document.(Available at:)http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/BloodVaccinesandOtherBiologics/VaccinesandRelatedBiologicalProductsAdvisoryCommittee/UCM279681.pdf([Accessed March 2015])
- Pneumococcal vaccines: WHO position paper – 2012.in: Weekly epidemiological record no. 14. 87. 2012: 129-144
- Supporting active ageing through immunisation (SAATI) partnership.(Available at:)http://www.ilcuk.org.uk/index.php/publications/publication_details/adult_vaccination_a_key_component_of_healthy_ageing([Accessed March 2015])
- Vaccination coverage in German adults: results of the German health interview and examination survey for adults (DEGS1).Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013; 56: 845-857
- 2009 adult vaccination survey: summary results.Australian Institute of Health, Canberra, Australia2011
- Relationship between public subsidies and vaccination rates with the 23-valent pneumococcal vaccine in elderly persons, including the influence of the free vaccination campaign after the great East Japan earthquake.J Infect Chemother. 2014; 20: 450-453
- Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe.Adv Ther. 2014; 31: 1011-1044
- Enhanced service specification.https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/09/seasnl-flu-pneumococcal-upd.pdf([Accessed September 2016])
- Health protection report.[Accessed September 2016])
- Influenza and pneumococcal vaccine coverages in geriatric health care settings in France.Gerontology. 2007; 53: 382-387
- Assessing disparities in adult vaccination using multimodal approaches in primary care offices: methodology.J Urban Health. 2007; 85: 217-227
- Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques.PLoS One. 2013; 8e60273
- The burden of community-acquired pneumonia in the elderly: the Spanish EVAN-65 study.BMC Public Health. 2008; 8: 222
- Predictive and prognostic factors in patients with blood-culture-positive community-acquired pneumococcal pneumonia.Eur Respir J. 2016; 48: 797-807
- Invasive pneumococcal disease.http://ecdc.europa.eu/en/healthtopics/pneumococcal_infection/Pages/Annual-epidemiological-report-2016.aspx([Accessed September 2016])
- Progressive changes in pneumococcal carriage in children attending daycare in Portugal after 6 years of gradual conjugate vaccine introduction show falls in most residual vaccine serotypes but no net replacement or trends in diversity.Vaccine. 2012; 30: 3951-3956
- Effect of pneumococcal conjugate vaccination on serotype-specific carriage and invasive disease in England: a cross-sectional study.PLoS Med. 2011; 8e1001017
- Declines in pneumonia hospitalizations of children aged <2 years associated with the use of pneumococcal conjugate vaccines – Tennessee, 1998–2012.MMWR. 2014; 63: 995-998
- Early impact of 13-valent pneumococcal conjugate vaccines on community-acquired pneumonia in children.Clin Infect Dis. 2014; 58: 918-924
- Pneumococcal carriage in children and adults two years after introduction of the thirteen valent pneumococcal conjugate vaccine in England.Vaccine. 2014; 32: 4349-4355
- Effect of 13-valent pneumococcal conjugate vaccine on admissions to hospital 2 years after its introduction in the USA: a time series analysis.Lancet Respir Med. 2014; 2: 387-394
- Pneumococcal pneumonia prevention among adults: is the herd effect of pneumococcal conjugate vaccination in children as good a way as the active immunization of the elderly?.Curr Med Res Opin. 2015; 1–3
- Serotype prevalence in adults hospitalised with pneumococcal non-invasive community-acquired pneumonia.Thorax. 2012; 67: 540-545
- Retrospective epidemiological study for the characterization of community- acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain).BMC Infect Dis. 2012; 12: 283
- New evidence of risk factors for community-acquired pneumonia: a population-based study.Eur Respir J. 2008; 31: 1274-1284
- Risk factors for community-acquired pneumonia in adults: recommendations for its prevention.Commun Acquir Infect. 2015; 2: 32-37
- Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland.Am J Epidemiol. 1993; 137: 977-988
- Epidemiology of community-acquired pneumonia in adults: a population-based study.Eur Respir J. 2000; 15: 757-763
- British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009.Thorax. 2009; 64: iii1-ii55
- Impact of the pneumococcal conjugate vaccine on rates of community acquired pneumonia in children and adults.Vaccine. 2008; 26: 4947-4954
- Resource use by patients hospitalized with community-acquired pneumonia in Europe: analysis of the REACH study.BMC Pulm Med. 2014; 14: 36
- Healthcare utilization and cost of pneumococcal disease in the United States.Vaccine. 2011; 29: 3398-3412
- New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality.Thorax. 2009; 64: 1062-1069
- Community-acquired pneumonia requiring hospitalization among U.S. adults.N Engl J Med. 2015; 373: 415-427
- Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differences, in a public healthcare system.Respir Med. 2012; 106: 1778-1787
- Long-term survival following pneumococcal pneumonia.Clin Infect Dis. 2013; 56: 1145-1146
- Community-acquired pneumonia: symptoms and burden of illness at diagnosis among US adults aged 50 years and older.Patient. 2013; 6: 125-134
- The association between pneumococcal pneumonia and acute cardiac events.Clin Infect Dis. 2007; 45: 158-165
- General and health-related life satisfaction of patients with community-acquired pneumonia.Psychol Health Med. 2009; 14: 331-342
- EPOC y neumonía.Arch Bronconeumol. 2010; 46: 28-31
- Observational longitudinal study of symptom burden and time for recovery from community-acquired pneumonia reported by older adults surveyed nationwide using the CACAP burden of illness questionnaire.Patient Relat Outcome Meas. 2015; 6: 215-223
- Clinical and economic burden of community-acquired pneumonia among adults in Europe.Thorax. Jan 2010; 67: 71-79
- Direct cost of treatment in hospitalized community-acquired pneumonia patients.World J Pharm Sci. 2015; 3: 478-483
- Vaccine immunology.in: Plotkin Vaccines. 5th edn. 2008: 17-36
- Maintaining protection against invasive bacteria with protein–polysaccharide conjugate vaccines.Nat Rev Immunol. 2009; 9: 213-220
- Prevenar 13 SPC.March 2015
- Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults.N Engl J Med. 2015; 372: 1114-1125
- European lung white book – chapter 18.(Available at:)[Accessed January 2016])
- Vaccines for preventing pneumococcal infection in adults (review).Cochrane Database Syst Rev. 2013;
- Efficacy of pneumococcal vaccination in adults: a meta-analysis.CMAJ. 2009; 180: 48-58
- Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naïve adults 60–64 years of age.Vaccine. 2014; 32: 2364-2374
- Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine.Vaccine. 2013; 31: 3585-3593
- A randomized, double-blind trial to evaluate immunogenicity and safety of 13-valent pneumococcal conjugate vaccine given concomitantly with trivalent influenza vaccine in adults aged ≥65 years.Vaccine. 2011; 29: 5195-5202
- Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults.Clin Vaccine Immunol. 2012; 19: 1296-1303
- Sensitivity, specificity, and positivity predictors of the pneumococcal urinary antigen test in community-acquired pneumonia.Ann Am Thorac Soc. 2015; 12: 1482-1489
- Epidemiology of community-acquired pneumonia in older adults: a population-based study.Respir Med. 2009; 103: 309-316
- Flu vaccination coverage, United States, 2014–15 influenza season.(Available at:)[Accessed October 2015])
MMWR Vaccination Coverage Among Adults, Excluding Influenza Vaccination—2013.
- Seasonal influenza vaccination in Europe — overview of vaccination recommendations and coverage rates in the EU member states for the 2012–13 influenza season.ECDC, Stockholm2015 ([A])
- National seasonal influenza vaccination survey, March 2014.ECDC, Stockholm2015 ([B])
European Centre for Disease Prevention and Control. Surveillance of invasive bacterial diseases in Europe, 2012. Stockholm: ECDC; 2015.
- Streptococcus pneumoniae.in: Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th edn. 2010: 2623-2642
- The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England.J Infect. 2012; 65: 17-24
- Invasive pneumococcal infections among persons with and without underlying medical conditions: implications for prevention strategies.BMC Infect Dis. 2008; 8: 96
- Rates of pneumococcal disease in adults with chronic medical conditions.Open Forum Infect Dis. 2014; 1ofu024
- Bacterial pneumonia among HIV-infected patients: decreased risk after tobacco smoking cessation. ARNS CO3 Aquitaine cohort, 2000–2007.PLoS One. 2010; 5e8896
- Risk factors for community-acquired pneumonia in adults in Europe: a literature review.Thorax. 2013; 68: 1057-1065
- Acid-suppressive drugs and community-acquired pneumonia.Epidemiology. 2009; 20: 800-806
- The natural history of community-acquired pneumonia in COPD patients: a population database analysis.Respir Med. 2012; 106: 1124-1133
- Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease.Thorax. 2015; 10: 984-989https://doi.org/10.1136/thoraxjnl-2015-206780
- Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/stand.(Available at:)[Accessed December 2015])Date: August 2014
- Aggiornamento delle indicazioni sulle vaccinazioni per la prevenzione delle malattie invasive batteriche nelle persone con patologie o condizioni di rischio.(Available at:)Date: 2014http://www.saluter.it/documentazione/leggi/regionali/comunicazioni/malattie_batteriche_indicazioni_2014.pdf/view([Accessed December 2015])
- Infections invasives à pneumocoque: recommandations vaccinales pour les personnes à risqué.(Available at:)[Accessed December 2015])
- Immunisation against infectious disease — the green book.(Available at:)[Accessed December 2015])
- Smoking and alcohol abuse are the most preventable risk factors for invasive pneumonia and other pneumococcal infections.Int J Infect Dis. 2014; 25: 59-64
- Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial.BMJ. 2010 Mar 8; 340: c1004
- With these cost-savings possible, encouraging vaccination uptake through education and improved infrastructure to overcome vaccine hesitancy is imperative.Eur Respir J. 2015; 46: 1407-1416
- The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers.BMJ Open. 2015; 29: e009062