Pneumococcal immunization in older adults: Implications for the long-term-care setting

Mark Loeb, Kurt B. Stevenson, Suzanne Bradley, Kent Crossley, Nelson Gantz, Lindsay Nicolle, Rodolfo Quiros, Andrew Simor, Philip Smith, Lynn Steele

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVES: To compare the efficacy of the polysaccharide pneumococcal vaccine in older adults between clinical trial and observational studies and to discuss the implications for long-term-care facilities (LTCFs). DATA SOURCE: A Medline search (to April 2003). STUDY SELECTION: All meta-analyses of randomized and quasi-randomized trials of pneumococcal vaccines with placebo or no treatment were sought. All cohort or case-control studies were sought. DATA SYNTHESIS: Of the 16 individual randomized clinical trials included in the reviews, 8 compared pneumococcal vaccine in individuals 55 years and older individuals. Only one study specifically addressed LTCF residents, Although no significant protective effect of the vaccine in elderly subpopulations was found, on the basis of wide confidence intervals and small subpopulation sample sizes, beneficial effects, particularly for pneumococcal bacteremia, could not be ruled out. Of the individual observational studies, 11 specifically evaluated vaccine efficacy in older adults. Vaccine efficacy was demonstrated in 9 of the 11 studies with no protective effect was shown in 2 studies. CONCLUSION: Although the pooling of clinical trial data does not demonstrate significant efficacy of the pneumococcal polysaccharide vaccine in subgroups of older adults, these subgroup studies lacked power to show significant differences. Observational studies repeatedly demonstrate efficacy in older adults, and the vaccine has been demonstrated to be cost-effective and safe. It is strongly promoted by U.S. and Canadian advisory committees. On the basis of this available evidence, the pneumococcal polysaccharide vaccine should currently be recommended for older adults, especially those who are residents of LTCFs.

Original languageEnglish (US)
Pages (from-to)985-994
Number of pages10
JournalInfection Control and Hospital Epidemiology
Volume25
Issue number11
DOIs
StatePublished - Nov 1 2004

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Pneumococcal Vaccines
Long-Term Care
Immunization
Vaccines
Observational Studies
Clinical Trials
Advisory Committees
Bacteremia
Sample Size
Meta-Analysis
Case-Control Studies
Randomized Controlled Trials
Placebos
Confidence Intervals
Costs and Cost Analysis

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Loeb, M., Stevenson, K. B., Bradley, S., Crossley, K., Gantz, N., Nicolle, L., ... Steele, L. (2004). Pneumococcal immunization in older adults: Implications for the long-term-care setting. Infection Control and Hospital Epidemiology, 25(11), 985-994. https://doi.org/10.1086/502331

Pneumococcal immunization in older adults : Implications for the long-term-care setting. / Loeb, Mark; Stevenson, Kurt B.; Bradley, Suzanne; Crossley, Kent; Gantz, Nelson; Nicolle, Lindsay; Quiros, Rodolfo; Simor, Andrew; Smith, Philip; Steele, Lynn.

In: Infection Control and Hospital Epidemiology, Vol. 25, No. 11, 01.11.2004, p. 985-994.

Research output: Contribution to journalArticle

Loeb, M, Stevenson, KB, Bradley, S, Crossley, K, Gantz, N, Nicolle, L, Quiros, R, Simor, A, Smith, P & Steele, L 2004, 'Pneumococcal immunization in older adults: Implications for the long-term-care setting', Infection Control and Hospital Epidemiology, vol. 25, no. 11, pp. 985-994. https://doi.org/10.1086/502331
Loeb, Mark ; Stevenson, Kurt B. ; Bradley, Suzanne ; Crossley, Kent ; Gantz, Nelson ; Nicolle, Lindsay ; Quiros, Rodolfo ; Simor, Andrew ; Smith, Philip ; Steele, Lynn. / Pneumococcal immunization in older adults : Implications for the long-term-care setting. In: Infection Control and Hospital Epidemiology. 2004 ; Vol. 25, No. 11. pp. 985-994.
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