Adult pneumococcal vaccination guideline. SAMA-SA Pulmonology Society Working Group.

OBJECTIVE: To outline a rational cost-effective protocol for pneumococcal vaccination of adults in South Africa. VACCINE DESCRIPTION: A highly purified vaccine containing 25 micrograms of each of 23 capsular polysaccharides representing > or = 85% of the serotypes causing pneumonia and invasive pneumococcal disease in the community. Polysaccharide antigens induce type-specific antibodies that enhance opsonisation, phagocytosis and killing of pneumococci by phagocytic cells. Factors influencing the efficacy of the vaccine include the age of the individual, the state of their immune response, the presence/absence of underlying medical disorders, and the level of pneumococcal antibodies attained. Protection is only against infection caused by pneumococci of a serotype included in the vaccine. RECOMMENDATIONS: Vaccination is potentially beneficial to any individual very effective in young otherwise healthy individuals targeted at high-risk groups when there are cost considerations. EVIDENCE: Detailed literature review with emphasis on local South African studies. Benefits, harms, costs. Vaccine is very effective in preventing pneumonia and invasive disease in young otherwise healthy individuals. Efficacy is greater against bacteraemic pneumonia than against non-bacteraemic pneumonia. Efficacy may be less in the elderly aged > 65 years and in some of the high-risk categories of individuals targeted for vaccination. Vaccine is safe with only occasional reports of anaphylaxis, although local reactions to the vaccine are quite common. CONTRAINDICATIONS: Exercise care when administering the vaccine to allergic individuals. Delay immunisation if possible in the case of fever, acute disease, and relapse of chronic disease until recovery. Relatively few data are available on cost-effectiveness of the vaccine. However, recent studies suggest that the vaccine is cost saving in developed countries in terms of prevention of bacteraemia alone. VALIDATION: Endorsement by the SA Pulmonology Society, SAMA and all who attended a multidisciplinary consensus meeting to consider the draft guideline.