No 2 - 2012

Conjugate pneumococcal vaccine approved for use in adults above 50 years

The 13-valent conjugate pneumococcal vaccine (Prevenar 13^®) has been approved by the EMA (European Medicines Agency) for prevention of invasive disease caused by Streptococcus pneumoniae (IPD) in adults above 50 years of age. The approval of Prevenar 13® was based on the antibody response being the same or higher for the 12 types of pneumococci it shares with the previously approved 23-valent pneumococcal polysaccharide vaccine (Pneumovax^®). The vaccine is administered as a single dose. The need for any revaccination has yet to be determined.

In studies where Prevenar 13^® was administered one year after Pneumovax®, the immune response was lower for all serotypes than the immune response following Prevenar 13^® given to subjects who had not previously been treated with Pneumovax®. The clinical relevance hereof remains unknown, but if the use of both Pneumovax® and Prevenar 13® are regarded expedient, Prevenar 13^® should be given first. Furthermore, in such cases, the vaccines should be given at a minimum interval of one year.

Commentary

The use of pneumococcal conjugate vaccine in the Danish Childhood Vaccination Programme has halved the incidence of IPD in children below the age of two years, EPI-NEWS 19/11. Furthermore, an indirect effect among adults aged 50-64 years and 65+ years  was achieved in the form of an IPD incidence decrease of approx. 10% in both of the abovementioned groups to 21 and 60 cases/105, respectively.

In 2010 and 2011, the 13 pneumococci types covered by  Prevenar 13^® caused a total of 52% of IPD cases in adults above 50 years, whereas the 23 serotypes covered by Pneumovax^® caused 81%.

Pneumovax^® can be ordered free of charge at the SSI for patients who have undergone or are scheduled for a splenectomy and for patients with splenic dysfunction (e.g. following radiation).

Furthermore, the National Board of Health has decided that Pneumovax^® shall be covered by a specific subsidy for the following patient groups who are considered at increased risk of IPD:

• scheduled or planned organ transplantation or cochlea implantation
• leakage of cerebrospinal fluid
• previous IPD
• immunosuppression (e.g. in connection with HIV infection or lymphoma).

Furthermore, subsidies are granted to persons under 18 years of age who are at an increased risk of IPD, EPI-NEWS 11/07. 

Since 1997, quite a few persons above 65 years have been vaccinated with Pneumovax^®, EPI-NEWS 46/02. The IPD incidence peaks in this age group. Vaccination is not covered by any programme and patients themselves defray any vaccination costs. Pneumovax^® prevents approx. 70% of IPD in adults, but no strong documentation exists in support of its preventive capacity against pneumococcal pneumonia.

With the new approval, Prevenar 13^® may be used, at the cost of the patient, for prevention of IPD in adults above 50 years, the drug may be ordered at the SSI in single-vaccine packages. Prevenar 13® is expected to cause a T-cell mediated immune response and thereby development of immunological memory. Pneumovax®  is expected to have a broader coverage against IPD.

A major randomized placebo-controlled trial is currently underway in Holland, the objective of which is to determine the clinical efficacy of Prevenar 13^® in IPD and pneumococcal pneumonia. Results will expectedly be published in 2013. Until the results from major studies are available, the clinical efficacy of Prevenar 13^® versus Pneumovax^® cannot be determined, nor can the expected effect of a pneumococcal vaccination programme for the elderly.

(P. Valentiner-Branth, P.H. Andersen, Dept. of Epidemiology, L. Lambertsen, H. Ingels, S. Hoffmann, DBMP)

Eurosurveillance fifteen year anniversary 1996-2011

Eurosurveillance, the European peer-reviewed scientific journal devoted to the epidemiology, surveillance, prevention and control of communicable diseases, focuses on topics that are of relevance to Europe. In the last three years (2009–2011) alone more than 600 articles have been published from 29 countries in the EU/EEA grouping and over 30 countries in the rest of the world. Presenting timely information about ongoing outbreaks and relevant information on trends in infectious diseases from all European countries to enable timely public health action is one of the Eurosurveillance’s main goals.

During the 2009 pandemic, the rapid turnover of concise, authoritative, peer-reviewed information received worldwide attention. By 10 August 2010, the official end of the pandemic, over 120 papers had been published, mostly rapid communications. On several instances the journal was the first scientific journal to report on outbreaks or emerging or reemerging diseases. In 2011 for example, the first reports about the Shiga toxin/verotoxin-producing Escherichia coli O104 in Germany  and the malaria outbreak in Greece were published in Eurosurveillance. Other examples cover emerging resistance to gonorrhoea (2010) and West Nile virus infections in Europe (2010) and there are many more.

A recent reader survey showed that most of the journal’s readers are working in epidemiology/public health of infectious diseases and a high number are microbiologists. Many readers and contributors to the journal are in senior positions across the world, and use the journal in their everyday work. This highlights the opportunity for information published to be picked up and translated into public heath action.

Eurosurveillance was founded in 1995 and jointly funded until March 2007 by the European Commission, the Institut de Veille Sanitaire (InVS) in Paris, France and the Health Protection Agency (HPA) in London, United Kingdom. Since March 2007, Eurosurveillance has been published by ECDC in Stockholm, Sweden.

Since its beginning, the journal has been open-access and as non-profit publication has no financial conflicts of interest. All articles in Eurosurveillance are indexed by PubMed/ MEDLINE, Scopus, and Embase.

Eurosurveillance has been selected for coverage by Thomson Reuters and is indexed and abstracted in the Science Citation Index Expanded (also known as SciSearch) and in the Journal Citation Reports/Science Edition beginning with Volume 14(1) 2009. The first Impact is expected to be allocated in the course of 2012. In January 2010, Eurosurveillance was accredited by the Health on the Net (HON) Foundation, www.hon.ch, as adhering to the HON code of conduct (HONcode). HON is a nongovernmental, non-profit organisation with the purpose of supporting users to identify sound, reliable and trustworthy health information on the Internet.

(Eurosurveillance Editorial Team)

11 January 2012