A one-off injection of pneumococcal polysaccharide vaccine (PPV) was recommended by the Department of Health in 2003 for all people over the age of 65 years and those under 65 years who fall into one of the clinical at-risk groups.

65 year olds and older programme

The JCVI questioned the efficacy of PPV and its duration of protection and in early 2011 proposed a discontinuation of the adult PPV programme. This decision was subsequently reversed based on evidence of greater efficacy than first thought, and in particular the low cost of PPV that makes the programme relatively inexpensive to implement.

The JCVI will continue to review the adult programme, particularly in light of herd protection from the childhood programme and the possible wider use of conjugate vaccines in adults. (PCV13 is currently licensed for under 5’s only.)

At risk groups

The JCVI has noted that effectiveness of PPV in patients in clinical risk groups, especially those with immunocompromised conditions, is unlikely to be strong nor long-lasting.

Therefore, the use of the conjugate vaccine in clinical risk groups is under consideration. There are potential benefits for the use of the conjugate vaccine as available immunogenicity data suggests it may provide a comparatively stronger and longer lasting immune response (however, it has been noted that there  are limitations to the data, as functional antibody data in some studies are lacking and most studies are small).

A decision on the use of the conjugate vaccine will be made following a cost-effectiveness analysis.