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Rapport

Efficacy and effectiveness of pneumococcal vaccination in elderly – an update of the literature

Publisert

This work is a collaboration between colleagues at the Norwegian, Swedish and Danish Public Health Institutes based on a common need for an updated knowledgebase to inform national guidelines for pneumococcal vaccination in medical risk groups and elderly.

Pneumococcal vaccines in elderly_OMSLAG_web.png

This work is a collaboration between colleagues at the Norwegian, Swedish and Danish Public Health Institutes based on a common need for an updated knowledgebase to inform national guidelines for pneumococcal vaccination in medical risk groups and elderly.


Norsk sammendrag

Introduksjon

Små barn, eldre og personer med svekket immunforsvar har høyest risiko for å få invasiv pneumokokksykdom og pneumokokkpneumoni. To ulike vaksiner er tilgjengelig for å forebygge pneumokokksykdom hos voksne; en 23-valent polysakkarid vaksine (PPV23) og en 13-valent konjugat vaksine (PKV13). Denne litteraturgjennomgangen vil brukes som grunnlag for oppdaterte nasjonale anbefalinger for bruk av pneumokokkvaksiner hos eldre i Norge, Sverige og Danmark.

Metode

Rapporten inkluderer publikasjoner om effekt av PKV13 og PPV23 fra 2000 til april 2019 fra randomiserte kontrollerte studier og observasjonsstudier. Utfall inkluderer invasiv pneumokokksykdom og pneumokokkpneumoni.

Resultater

Totalt 27 artikler er inkludert; 18 publikasjoner om effekt av PPV23 og ni publikasjoner om effekt av PKV13. Ingen studier har sammenlignet effekt av PKV13 og PPV23 direkte. Kunnskapsgrunnlaget for effekt av PKV13 hos eldre domineres av en stor randomisert studie med i hovedsak friske eldre. For PPV23 er kunnskapsgrunnlaget basert på randomiserte studier med moderat kvalitet og en rekke observasjonsstudier. Forskjell i studiepopulasjoner, studiedesign og tid siden vaksinasjon gjør det vanskelig å oppsummere effektestimat i entydige kvantitative mål.

Effekt av PPV23 for forebygging av invasiv pneumokokksykdom er på linje med tidligere systematiske litteraturgjennomganger, og i samsvar med PKV13 effekt-estimater. Effekt-estimater var konsistente på tvers av observasjonelle studier og økologiske studier med overvåkingsdata for den generelle eldre befolkningen. PKV13 ser ut til å gi bedre beskyttelse enn PPV23 for serotyper som inngår i begge vaksinene. Vi fant at både PPV23 og PKV13 er effektive i å forebygge pneumokokkpneumoni hos eldre på sammenlignbare nivå. Effekt-estimater for PPV23 var høyere i kontrollerte studier enn i observasjonsstudier, noe som muligens reflekterer kortere oppfølgingstid og dermed mindre betydning av fallende immunitet. Både PPV23 og PKV13 viste generelt lavere effekt med økende alder for alle utfall og hos personer med immunsvekkende tilstander. I hovedsak ble det ikke vist signifikant vaksineeffekt hos personer med immunsvekkelse.

Konklusjon

Rapporten viser at både PKV13 og PPV23 beskytter mot invasiv pneumokokksykdom og pneumokokkpneumoni hos eldre. Det totale kunnskapsgrunnlaget viser at effekt av PPV23 er på sammenlignbart nivå som PKV13. Dette er av stor betydning for folkehelsen på grunn av den høye sykdomsbyrden knyttet til pneumokokkpneumoni. Det er viktig å legge seortypefordeling i bærerskap og sykdom til grunn for å vurdere nytten av vaksinasjon. Den lave andelen pasienter som i dag blir syke med serotyper som inngår i PKV13 antyder begrenset potensiale for forebygging fra PKV13 vaksinasjon hos voksne.  Vel-designede og serotype-spesifikke randomiserte kontrollerte studier er nødvendige for å forbedre kunnskapsgrunnlaget.

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Om rapporten

  • Utgitt: 12/2019
  • Av: Folkehelseinstituttet
  • Forfattere: Winje BA, Berild JD, Vestrheim DF, Denison E, Lepp T, Roth A, Valentiner-Branth P, Slotved HC, Storsæter J .
  • ISBN elektronisk: 978-82-8406-053-8