Anti-pneumococcal vaccination in the elderly

A severe disease: Pneumococcal infections-including pneumonia, bacteremia and meningitis-are important causes of hospitalization and death among elderly patients. Overall deaths from pneumococcal disease are estimated at 4000 to 12000 per year in France. Considering the increasing of pneumococcal resistance level to antibiotics used in the treatment of invasive infections (21-36%) and the high mortality (10-30%), even with susceptible strains, the vaccinal approach has to be envisaged. This article reviews current issues in clinical practice and public policy for pneumococcal vaccination in the elderly. Efficacy of the pneumococcal vaccine: The present polysaccharidic vaccine (23-valent) proved its protective efficacy against serious pneumococcal infections in immunocompetent elderly patients (70-80%). Studies that have not been able to demonstrate a protective effect of pneumococcal vaccination have been criticised, particularly for their small sample size and limited statistical power. However, in France, the vaccination coverage is still < 1%. Doubts about it; effectiveness, fears of side effects, and the lack of programs to promote its use contribute to the underuse of this vaccine. Recommendations: Because pneumococcal vaccination is safe, efficacious and probably cost-effectiveness, we conclude that specific recommendations for this vaccine in the elderly are necessary in France. (C) 1998, Masson, Paris.