P. Leophonte et F. Neukirch, Anti-pneumococci vaccination: role and indications in the prevention of community acquired infections of the lower respiratory tract., MED MAL INF, 31(4), 2001, pp. 181-194
Objective - The authors had for aim to evaluate the effectiveness and clini
cal indications of the anti pneumococcal vaccine.
Methods - Seventy one articles were selected after a computerized research
including the most recent studies on immunogenicity, all the prospective do
uble blind randomized trials, and retrospective studies (case-control and i
ndirect cohort studies). The evaluation concerned exclusively non conjugate
d vaccine.
Results - The immune response was significant among vaccinated patients inc
luding elderly ones; antibody response was reduced or absent among immune-c
ompromised patients. Only one study among 11 randomized trials concerned th
e 23-valent vaccine. According to the results of these trials and of 2 meta
-analyses, efficacy in preventing pneumococcal bacteremia and pneumococcal
pneumonia is clearly established in young adults (with a response rate reac
hing around 80% for vaccine serotypes). Clinical studies in older adults, a
dults with risk factors, or immune-compromised adults are inconclusive, usu
ally because the number of patients was too small. Retrospective case-contr
ol and indirect cohort studies confirmed the clinical efficiency of pneumoc
occal vaccination. They showed that pneumococcal vaccination was efficient
in 50-80% of the patients to prevent invasive pneumococcal diseases, includ
ing in older patients and those with associated diseases, particularly with
COPD or cardiovascular diseases. Efficiency was not demonstrated in immune
-compromised patients. The vaccine proved safe with a good tolerance. Vacci
nation is recommended by the WHO and various advisory national committees i
n North America and Europe for elderly patients and those with associated d
iseases. (C) 2001 Editions scientifiques et medicales Elsevier SAS.