Personalizing pneumococcal vaccination recommendations: The Saudi Thoracic Society guidelines.

Streptococcus pneumoniae is one of the main pathogens causing infections in children and adults. In children, it can cause meningitis, otitis media, and pneumonia, while in adults, it is mainly responsible for invasive and noninvasive community-acquired pneumonia (CAP). The burden of the disease is a very high in terms of morbidity and mortality. For example, in adults, mortality can reach up to 30% in severe CAP cases admitted to the Intensive Care Unit.[1] The positive side of all of this is that S. pneumoniae infection is a potentially preventable disease. For many years, we have used PPV23 valent vaccine in adults to prevent invasive pneumococcal disease (IPD). The introduction in children of the conjugated (pneumococcal conjugate vaccine [PCV] 7 and PCV13) vaccines has been followed by a decrease in pneumococcal IPD, and non-IPD disease in children and by a herd-immunity effect in adults (in IPD in non-IPD CAP).[23] The “CAPITA”[4] study has confirmed the efficacy of PCV13 in adults over 65 years of age, showing 45% efficacy in protecting against the first episode of vaccine-type (VT) pneumococcal CAP and 75% in preventing the first episode of VT IPD.

The availability of the conjugated vaccines and the results of CAPITA studies have had a fundamental influence on the USA and EU recommendations for pneumococcal vaccination.[56] In the US, these recommendations, issued by the Advisory Committee on Immunization Practices, are consistent for the whole country. This is not the case in Europe, where each country has modifications according to age or risk factors and budget. In this issue of Annals of Thoracic Medicine, a group of Saudi experts provides recommendations for pneumococcal vaccination. The most important aspect of these guidelines is the recommendation of universal vaccination of all adults over 50 years of age.

This recommendation is based on the following arguments:

(1) High prevalence of sickle-cell disease, which is a disease with a high risk for S. pneumoniae infection; (2) high prevalence of chronic diseases in younger age groups; (3) prescription of over-the-counter antibiotics in private pharmacies, which increases the risk of S. pneumoniae resistant to antibiotics. In addition, very importantly, Saudi Arabia has to face a unique every year situation because of the Hajj and Umrah season, in which there is an increased risk of respiratory tract infections, including S. pneumonia.[7] The panel of experts from the Saudi Thoracic Society believes that these arguments justify the recommendation for the universal pneumococcal vaccine in patients over 50 years of age.[8]