P2.2 Pneumococcal immunisation

Pneumococcal immunisation is known to be highly effective in preventing invasive bacteraemic pneumococcal pneumonia (Bonten 2015). It may be less effective in elderly or immunosuppressed patients (Simberkoff 1986). There is no direct evidence of its efficacy in preventing pneumococcal exacerbations of COPD (Walters 2011 [evidence level I], but prevention of pneumonia in these patients with already reduced respiratory reserve is a worthy goal in its own right (Simberkoff 1986, Williams 1986, Davis 1987), so pneumococcal immunisation (polyvalent cover­ing 23 virulent serotypes) is recommended in this group [evidence level II] (Global Initiative for Chronic Obstructive Lung Disease 2016). There is no evidence or rationale for immunising more frequently in COPD. 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.