title: Efficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence.
abstract: We review studies on the efficacy against disease caused by Streptococcus pneumoniae of the 23-valent polysaccharide pneumococcal vaccine in adult populations in the more developed countries. Meta-analyses of primary vaccine trials have attempted to reduce uncertainty from lack of power. Vaccine efficacy calculated from studies in South African gold-miners and in Papua New Guinea, with high attack rates and differing serotype patterns, cannot automatically be applied to more developed countries. Meta-analyses will overestimate a protective effect if this clinical heterogeneity is ignored. Meta-analyses limited to trials in the more developed setting show no protective effect against pneumococcal pneumonia and a non-significant protective effect against bacteraemia. Lack of a specific diagnosis limits the ability to detect a protective effect against pneumococcal pneumonia. Most, but not all, observational studies confirm a protective effect against bacteraemia. An effect on mortality in more developed countries has yet to be documented.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. Punam.Mangtani@lshtm.ac.uk
authors.forename: Punam
authors.initials: P
authors.lastname: Mangtani
authors.forename: Felicity
authors.initials: F
authors.lastname: Cutts
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hall
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000517:prevention & control; D019049:Developed Countries; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D022242:Pneumococcal Vaccines