Pneumococcal vaccination for healthy elderly: a comment.

In contrast to many other Western countries there is still a debate in the Netherlands about whether pneumococcal vaccination is of benefit for healthy elderly people. In 1982 the Health Council of the Netherlands issued a report on this subject and concluded that there was no scientific background for vaccinating people only based on age over 65 years. 1 In the meantime pneumococcal vaccination for the elderly has been introduced in a number of Western countries and this was the reason for preparing a new report within the Health Council. 2 Pneumococcal vaccination was introduced before the Second World War. 3 Vaccination has been very successful in younger populations with healthy individuals living in special conditions with a high incidence of pneumococcal disease, such as young miners in South Africa and people living in the highlands of New Guinea. 4 Later on, there appeared to be more difficulties in elderly people and people with conditions influencing their immune status. Early vaccine was based on 2-4 pneumococcal serotypes. Later 6-13 and 14-valent vaccines were developed. At this moment, 23-valent polysaccharide vaccines are mainly used. For children a special vaccine has been developed with an antigen conjugated to protein. A 7-valent conjugate vaccine is currently being used. It will probably not be possible to develop a more than 10-valent vaccine in the near future. After vaccination, protection against infection starts after two to three weeks. The duration of the protection is uncertain. In healthy adults, antibody is present up to five years after vaccination. Local erythema and pain at the site of injection occur frequently. 5 Systematic reactions are rare. These side effects are more frequent in patients who have had a pneumococcal vaccination with an earlier vaccination within three years and in patients with a history of a pneumococcal infection during the three years before the vaccination. 6 Pneumococcal vaccination is often combined with vaccination against influenza. The latter is given each year, pneumococcal vaccination every five years. There is no problem in giving both vaccinations at the same time if different injection sites are used. It could be that adding pneumococcal vaccination to the regular vaccination against influenza in the Netherlands would lower the adherence to the influenza vaccination programme. Opstelten and colleagues did a pilot study in Dutch general practices and found no significant decline in the number of older patients coming for their yearly flu vaccinations. A small …