Marcia Frellick

April 30, 2015

COPENHAGEN, Denmark — The 13-valent conjugated pneumococcal vaccine (PCV13) commonly used in children is effective in older adults for the prevention of vaccine-type community-acquired pneumonia and invasive pneumococcal disease, and the effect lasts for at least 4 years, according to one of the largest vaccine efficacy trials in history.

This study is "pivotal and critically important," said Greg Poland, MD, director of the Mayo vaccine research group in Rochester, Minnesota, and editor-in-chief of Vaccine.

"I say critical because community-acquired pneumonias are common among older persons, and can be deadly, causing considerable morbidity and mortality," he told Medscape Medical News here at the 25th European Congress of Clinical Microbiology and Infectious Diseases.

Marc Bonten, MD, from the University Medical Center in Utrecht, the Netherlands, presented results from the Pfizer-funded Community-Acquired Pneumonia Immunization Trial in Adults, or CAPiTA. The study was published in a recent issue of the New England Journal of Medicine.

The trial involved 84,496 adults 65 years and older. Half were randomly assigned to receive PCV13 and the other half were assigned to receive placebo.

The rate of first episodes of vaccine-type community-acquired pneumonia was 45.6% lower in the vaccine group than in the placebo group (95.2% confidence interval [CI], 21.8 to 62.5; P < .001); the rate of nonbacteremic and noninvasive community-acquired pneumonia was 45.0% lower (95.2% CI, 14.2 - 65.3; P =.007); and the rate of vaccine-type invasive pneumococcal disease was 75% lower (95% CI, 41.4 - 90.8; P < .001).

 
This trial demonstrated 75% efficacy against the most lethal complication — that of invasive pneumococcal pneumonia.
 

A month after vaccination, the rates of serious adverse events and deaths were similar in the vaccine and placebo groups. However, as expected, there were more local reactions — rash and generalized muscle pain, for example — in the vaccine group.

A standardized approach was used to identify patients with a clinical suspicion of community-acquired pneumonia in the emergency departments of 58 hospitals in the Netherlands.

Dr Bonten explained that the Netherlands was an ideal location for the study because it was one of the few countries that didn't adopt the recommendation to use the 23-valent pneumococcal polysaccharide vaccine (PPV23) to prevent pneumococcal infection in the elderly. In fact, patients previously treated with a pneumococcal vaccination were excluded from the analysis.

"This trial demonstrated 75% efficacy against the most lethal complication — that of invasive pneumococcal pneumonia. Importantly, the PCV13 vaccine covers well over 90% of the pneumococcal types that cause this disease. And there was no evidence of waning immunity or efficacy over the 4-year period of the study," said Dr Poland.

"We will need to educate physicians — who must recommend the vaccine to their patients — on the importance of immunization," he added. "Unlike a disease lay people have never heard of — say, HPV — pneumonia is something everyone has heard of and wishes to avoid. Among older people, they commonly hear of friends and family who are hospitalized or who died from this disease, and will be motivated to protect themselves against it."

This study was funded by Pfizer. Dr Bonten reports receiving consulting fees from Pfizer. Dr Poland reports serving in consultant or advisory roles for Merck, CSL Biotherapies, Avianax, Sanofi Pasteur, Dynvax, Novartis Vaccines and Diagnostics, PaxVax, Emergent Biosolutions, Adjuvance Technologies, and Vaxess.

25th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). Presented April 27, 2015.

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