SELECTED ARTICLES FROM THE RECENT LITERATURE 2003
11/26/03
Should pneumococcal immunization start at age 50?
Summary
The Advisory Committee on Immunization Practices has considered recommending
a lower age (50 years) for pneumococcal immunization (PnI) than the current
65 years age entry for PnI. Would this approach be cost effective? Sisk et
al of Mt. Sinai School of Medicine in New York analyzed the CDC data on Pn
incidence and case fatality rates in those 50-64 years old, the estimate
efficacy of PnI to prevent such infection and the cost estimates involved.
They concluded that PnI reduced medical costs and improve health,
particularly among high-risk African-Americans (with a mean saving of $27.55
per vaccine dose used). Although less prominent, there were savings
secondary to PnI in non-black vaccinees. The authors estimated that the cost
of PnI for the overall population per added year of healthy life was well
below that seen with established preventive screening programs such as colon
cancer screening.
Reference
Ann Intern Med 2003; 138:960-68
Editor's Comments
The conclusions in this report sound reasonable to me, particularly if one
is dealing with high-risk African-American patients. However, giving PnI at age
50 years does raise an issue that must be resolved. Some studies have shown that
serum levels of protective anti-PnI antibodies often decrease considerably
starting about 5-10 years post PnI in otherwise healthy individuals. However, it
is not known whether the protective effects of PnI are lost when anti-Pn
antibody levels decrease markedly. As pointed out in an accompanying editorial
by Gardner of the NIH, many physicians in community practice give repeat PnI at
5-10 year intervals without firm evidence about the duration of protection after
primary PnI and other aspects of immunization. At least one report described a
modestly increased incidence of large local reactions at the injection site
during repeat PnI (11% vs 3% in sites of primary PnI); however, no increased
frequency of systemic adverse reactions to repeat PnI were observed (JAMA 1999;
281:243-48).
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