Efficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence.
Mangtani, Punam;
Cutts, Felicity;
Hall, Andrew J;
(2003)
Efficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence.
The Lancet infectious diseases, 3 (2).
pp. 71-78.
ISSN 1473-3099
DOI: https://doi.org/10.1016/s1473-3099(03)00514-0
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
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.