Polysaccharide pneumococcal vaccines

Existing guidance is at variance with the evidence

Infection with Streptococcus pneumoniae (pneumococcus) is a leading cause of illness in young children and of illness and death in elderly people and people with immune deficiencies and chronic illness. Pneumococcus causes a spectrum of disease: infections of the upper respiratory tract, otitis media, invasive infections such as bacteraemia and meningitis, and infections of the lower respiratory tract such as pneumonia.^w1

Polyvalent pneumococcal polysaccharide vaccines containing more than one capsular antigen of pneumococcus have been around since the 1940s. The current 23-valent pneumococcal polysaccharide vaccine was introduced in the United States in 1983.^w2 Its antigenic composition reflects the incidence of the 23 serotypes in the causation of invasive disease, as well as coverage of themost prevalent serotypes.^w2 As each of the many pneumococcal serotypes has a different epidemiology and probably invasiveness this combined vaccine has a very broad spectrum.^w3

Pneumococcal polysaccharide vaccine is recommended in the United States for use in all people aged 65 years or more and in people at risk aged 2 years …