P2.2 Pneumococcal immunisation

Pneumococcal immunisation is recommended for all patients with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017). Pneumococcal immunisation with conjugated vaccines covering 13 virulent serotypes is highly effective in preventing vaccine-type invasive bacteraemic and non-bacteraemic community-acquired pneumococcal pneumonia in older adults (Bonten 2015). In contrast, the pneumococcal polysaccharide vaccine (covering 23 virulent serotypes) is less effective in elderly or immunosuppressed patients (Simberkoff 1986). People with COPD vaccinated with injectable polyvalent pneumococcal vaccines are less likely to experience an episode of community-acquired pneumonia (OR 0.62 (95% CI 0.43-0.89)) with a NNTB of 21 to prevent one episode of pneumonia (95% CI 15-74) and vaccination also reduces the likelihood of an exacerbation of COPD (OR 0.6 (95% CI 0.39-0.93)), NNT of 8 to prevent one exacerbation (95% CI 5-58) (Walters 2017) [evidence level I].  Evidence was insufficient in this meta-analysis by Walters et al for comparison of different pneumococcal vaccine types. Expert opinion is divided about whether to continue to advise use of the 23-valent polysaccharide vaccine or to replace its use with the far more effective conjugate vaccine. At present, the 23-valent polysaccharide vaccine is reimbursed for adults aged 65 years and over, and recommended in the current context.  Please see the link to The Australian Immunisation Handbook on the NHMRC’s website for further details: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-pneumococcal

The additive effect of pneumococcal immunisation to annual influenza immunisation has been studied in a randomised, controlled trial over two years in Japanese patients with chronic lung disease (Furumoto 2008). They found a significant additive effect of receiving both vaccines on exacerbations in patients with COPD (influenza vaccine alone = 26% vs. both vaccines =10.3%, p = 0.037), supporting current recommendations for dual immunisation.