Pneumococcal Pneumonia and Invasive Pneumococcal Disease in Those 65 and Older: Rates of Detection, Risk Factors, Vaccine Effectiveness, Hospitalisation and Mortality.

Roger E Thomas

doi:10.3390/geriatrics6010013

Abstract

Pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in seniors worldwide. Incidence rates and serious outcomes worsen with increasing frailty, numbers of risk factors and decreasing immune competence with increasing age. Literature reviews in Medline and Embase were performed for pneumococcal disease incidence, risk factors, vaccination rates and effectiveness in the elderly. The introduction of protein-conjugated pneumoccal vaccines (PCV) for children markedly reduced IPD and PP in seniors, but serotypes not included in vaccines and with previously low levels increased. Pneumococcal polysaccharide (PPV23) vaccination does not change nasal and pharyngeal carriage rates. Pneumococcal and influenza vaccination rates in seniors are below guideline levels, especially in older seniors and nursing home staff. Pneumococcal and influenza carriage and vaccination rates of family members, nursing home health care workers and other contacts are unknown. National vaccination programmes are effective in increasing vaccination rates. Detection of IPD and PP initially depend on clinical symptoms and new chest X ray infiltrates and then varies according to the population and laboratory tests used. To understand how seniors and especially older seniors acquire PP and IPD data are needed on pneumococcal disease and carriage rates in family members, carers and contacts. Nursing homes need reconfiguring into small units with air ventilation externally from all rooms to minimise respiratory disease transmission and dedicated staff for each unit to minimise transmision of infectious diseaases.

Highlights

Remschmidt identified two randomised controlled trials (RCTs), eight prospective and three retrospective cohort studies and one cross-sectional design
For Pneumococcal pneumonia (PP) for the two RCTs rated as low risk for this outcome vaccine effectiveness (VE) was 64% (35%, 90%; I2 = 0%) and for the cohort studies 48% (25%, 63%, I2 = 0%) [9]
Confirmation is by urinary antigen detection (UAD), sputum or blood cultures but a substantial number of cases, depending on the patient population tested, may depend on clinical symptoms and chest Xrays (CXR) because bacteremia is not ascertained in many pneumococcal pneumonias

Summary

Introduction

The Burden of Pneumococcal Disease and Issues in Reducing Incidence Among Seniors. Pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in seniors worldwide. In the nasopharynx the pneumococci secrete biofilms and the pneumococcal bacterial capsule facilitates their survival in colonised individuals by avoiding host immunological mechanisms that recognise pneumococcal capsular proteins. When pneumococci penetrate the host’s epithelium the colonies change from rough colonies to smooth colonies as the pneumococci upregulate their expression of pneumococcal capsular proteins. The bacteria migrate either to mucosal surfaces in the ear causing otitis media or the lungs causing pneumonia or are transmitted by blood vessels to multiple sterile sites causing invasive pneumococcal disease (IPD) in joints, bones, the heart, the peritoneal cavity, brain or lungs. Most pneumococcal pneumonias are not associated with detected bacteremia [1]

Results

Discussion

Conclusion