ANTI-PNEUMOCOCCAL VACCINATION IN THE ELDE RLY

A severe disease: Pneumococcal infections-including pneumonia, bactere mia and meningitis-are important causes of hospitalization and death a mong elderly patients. Overall deaths from pneumococcal disease are es timated at 4000 to 12000 per year in France. Considering the increasin g of pneumococcal resistance level to antibiotics used in the treatmen t of invasive infections (21-36%) and the high mortality (10-30%), eve n with susceptible strains, the vaccinal approach has to be envisaged. This article reviews current issues in clinical practice and public p olicy for pneumococcal vaccination in the elderly. Efficacy of the pne umococcal vaccine: The present polysaccharidic vaccine (23-valent) pro ved 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 h ave been criticised, particularly for their small sample size and limi ted statistical power. However, in France, the vaccination coverage is still < 1%. Doubts about it; effectiveness, fears of side effects, an d the lack of programs to promote its use contribute to the underuse o f this vaccine. Recommendations: Because pneumococcal vaccination is s afe, efficacious and probably cost-effectiveness, we conclude that spe cific recommendations for this vaccine in the elderly are necessary in France. (C) 1998, Masson, Paris.