Pneumococcal polysaccharide revaccination: immunoglobulin g
seroconversion, persistence, and safety in frail, chronically ill older
subjects.
Lackner TE, G Hamilton R, J Hill J, Davey C, Guay DR.
Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy,
University of Minnesota, Minneapolis, Minnesota 55455, USA. lackn001@umn.edu
OBJECTIVES: To determine the 1-month postpneumococcal
polysaccharide-revaccination immunoglobulin G (IgG) antibody response, its
persistence at 1 year, and tolerability of revaccination in frail, chronically
ill older nursing facility residents. DESIGN: Prospective study conducted
between December 1998 and July 2000. SETTING: Six skilled nursing facilities
in the Minneapolis-St. Paul, Minnesota, metropolitan area. PARTICIPANTS:
Sixty-seven subjects aged 65 and older having received primary vaccination
with pneumococcal polysaccharide vaccine (PPV) at least 5 years before
enrollment. INTERVENTION: Revaccination with one dose of 23-valent PPV.
MEASUREMENTS: Adverse events and concentrations of seven individual
pneumococcal polysaccharide type-specific IgG antibodies (against serotypes 4,
6B, 9V, 14, 18C, 19F, 23F) and their aggregate before and 1 and 12 months
after revaccination. RESULTS: A significant increase in all individual and
aggregate median antibody concentrations over baseline was observed 1 month
after revaccination. However, after 1 year, the increase remained significant
only for serotypes 6B and 18C and the aggregate parameter. One month after
revaccination, the mean increase in antibody concentration over baseline was
significantly greater than 1.4-fold for six of the seven serotypes and the
aggregate. However, the increase was not significantly greater than 1.4 at 1
year for any of the serotypes or the aggregate. Minor, self-limited localized
adverse reactions and systemic reactions occurred in 11.3% of the subjects.
CONCLUSIONS: In frail, chronically ill older nursing facility residents,
revaccination with 23-valent PPV at least 5 years after primary vaccination
(whether primary vaccination occurred before or after age 65) is associated
with a significant, albeit brief, immunological response for most of the
serotypes tested. Revaccination was well tolerated.
(Sherri J.
Tenpenny, D.O. is a nationally renowned and respected vaccine expert. In
August 2002, I hosted a timely and important teleconference featuring Dr.
Tenpenny to discuss the real dangers of vaccines and how you can legally avoid
them. "The
Danger of Vaccines, and How You Can Legally Avoid Them" audiotape, a
professionally recorded 90-minute cassette available in my "Recommended
Products" section, presents that full conference.)
The first pneumococcal
polysaccharide vaccine for adults was released in the 1940s but was withdrawn
from the market on the assumption that penicillin and sulfonamide drugs would
eradicate pneumococcal disease. When this proved to be untrue, the 23-valent
(antigen) vaccines were re-licensed, and widespread use began in 1980. The two
vaccines administered to adults in the United States today are Pneumovax 23
(produced by Merck) and Pnu-Immune 23 (produced by Wyeth-Lederle).
Pneumococcal disease is caused
by a type of bacteria called Streptococcus pneumoniae and more than 90 different
serotypes, or “cousins,” to this bacteria exist. The bacteria can cause
pneumonia, can invade the bloodstream (bacteremia) and, rarely, can cause
meningitis. The 23 strains that most frequently cause disease have been isolated
and a tiny portion of cell wall from each bacterium is extracted to form the
vaccine. This cell wall “piece” is called an antigen. Each antigen constitutes a
single vaccine because it stimulates a unique antibody response.
Therefore, a single injection of
Pnuemovax or Pnu-Immune is the equivalent of receiving 23 different vaccines at
one time. This antigen load is delivered directly into the blood stream and
causes quite a jolt to the immune system since the “normal” way that this type
of bacteria enters the body is through the nasal passages and lungs.
Since their initial release, the
23-valent “pneumonia” vaccines have been given to persons aged 50 years and
older, and until recently a single dose was considered to provide “lifetime
coverage.” Ongoing research has determined that the vaccine’s antigens stimulate
mature B lymphocytes to produce antibodies, but the antigens have no effect on
the T lymphocytes, the work-horses of the TH-1 pathways.
Without the TH-1 portion of the
immune system being involved, the effect of the vaccine will not be long
lasting.[1] This is a serious problem with all vaccines and the reason why none
of them provide lifetime immunity.
In the last three years,
“pneumonia vaccine booster” protocols have been developed to encourage
revaccination of the elderly. It now appears that the vaccine will be
recommended for annual use. Why is this being suggested? Is there any evidence
that the incidence in pneumococcal disease has increased over the last 10 years?
We gave a vaccine that at one
time supposedly provided lengthy protection. If it really wasn’t working,
wouldn’t there have been an increased incidence in pneumonia and meningitis in
the elderly, suggesting that we needed more vaccinations? I can find no evidence
of this in the medical literature. Therefore, is it really necessary to give
this vaccine at all?
The nation's Healthy People 2000
goals for pneumococcal vaccine state that 60 percent of persons aged 65 years
and older should receive the vaccine. [2] According to the 2000 Census Bureau
statistics, there were 56 million people aged 55 and older living in the United
States at that time, and that number is anticipated to grow to nearly 80 million
by the year 2030.[3]
Let’s do the math: 56 million x
60 percent x $14 (AWP/dose[4])--and that doesn’t include European sales. That’s
a lot of money, especially for something that is ineffective at best and at
worst unnecessary.
References
[1] Richard
Kent Zimmerman, MD, MPH. et.al. Routine Vaccines Across the Life Span, 2001. J
of Fam. Pr. Oct. 2001,Vol. 50, No. 10.
[2] 138. US
Department of Health and Human Services, Public Health Service: Healthy People
2000. Washington, DC, Government Printing Office, 1990
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
