Efficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence


Mangtani, P; Cutts, F; Hall, AJ; (2003) Efficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence. The Lancet infectious diseases, 3 (2). pp. 71-8. ISSN 1473-3099 DOI: 10.1016/S1473-3099(03)00514-0

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Abstract

We review studies on the efficacy against disease caused by Streptococcus pneumoniae of the 23-valent polysaccharide pneumococcal vaccine in adult populations in the more developed countries. Meta-analyses of primary vaccine trials have attempted to reduce uncertainty from lack of power. Vaccine efficacy calculated from studies in South African gold-miners and in Papua New Guinea, with high attack rates and differing serotype patterns, cannot automatically be applied to more developed countries. Meta-analyses will overestimate a protective effect if this clinical heterogeneity is ignored. Meta-analyses limited to trials in the more developed setting show no protective effect against pneumococcal pneumonia and a non-significant protective effect against bacteraemia. Lack of a specific diagnosis limits the ability to detect a protective effect against pneumococcal pneumonia. Most, but not all, observational studies confirm a protective effect against bacteraemia. An effect on mortality in more developed countries has yet to be documented.

Item Type: Article
Keywords: Adult, Aged, Bacteremia/prevention & control, *Developed Countries, Human, Meta-Analysis, Middle Age, Pneumococcal Infections/epidemiology/*prevention & control, *Pneumococcal Vaccines, Pneumonia, Pneumococcal/prevention & control, Randomized Controlled Trials, Support, Non-U.S. Gov't, Adult, Aged, Bacteremia, prevention & control, Developed Countries, Human, Meta-Analysis, Middle Age, Pneumococcal Infections, epidemiology, prevention & control, Pneumococcal Vaccines, Pneumonia, Pneumococcal, prevention & control, Randomized Controlled Trials, Support, Non-U.S. Gov't
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Vaccine Centre
PubMed ID: 12560191
Web of Science ID: 180749600018
URI: http://researchonline.lshtm.ac.uk/id/eprint/16771

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