New vaccine against pneumococcal disease approved for UK

Keith Alcorn
Published: 30 November 2011

A new vaccine that may be more suitable for preventing pneumococcal disease in people living with HIV has been approved in the United Kingdom.

Prevenar 13, manufactured by Pfizer, is targeted at 13 variants of Streptococcus pneumoniae.

Recently published research carried out by the Health Protection Agency shows that, among people with HIV, these variants cropped up in 61% of cases of invasive pneumococcal disease diagnosed in 2009. In contrast the PCV7 vaccine would have protected against only 23% of cases.

The Health Protection Agency research also showed that the incidence of invasive pneumococcal disease was 20 times higher among people with HIV compared with the general population.

Illness caused by Streptococcus pneumoniae is a common cause of ill health in the general population. In most people it causes mild health problems such as sinusitis and chest infections, but more severe cases of penumococcal disease can result in septicaemia, severe pneumonia or meningitis.

The risk of invasive and potentially life-threatening pneumococcal disease is higher in the over-50s and in people with suppressed immunity, chronic respiratory conditions such as asthma, heart, liver or kidney disease.

The Prevenar 13 vaccine has been licensed for use in adults aged 50 years and over.

Current UK vaccination policy is to offer the PPV-23 vaccine to adults aged 65 and over, and to adults in specified risk groups, including people living with HIV. The Joint Committee on Vaccination and Immunisations (JCVI) concluded in March 2011, on the basis of unpublished data provided by manufacturer Pfizer, that “there is no conclusive evidence that [the PCV-13] vaccine would be more effective in older adults”.

The JCVI made no specific recommendation regarding vaccination for people living with HIV, despite an initial recommendation from the JCVI’s Pneumococcal sub-committee that people with HIV with controlled viraemia should receive two doses of the PVC-13 vaccine followed by one dose of the PPV-23 vaccine.

2008 guidance from the British HIV Association recommended use of the PPV-23 vaccine in people living with HIV with CD4 cell counts above 200 cells/mm3, and that it should be considered for those with CD4 counts below 200. This recommendation was framed in the light of evidence of lower vaccine efficacy in people with CD4 counts below 200.

The British HIV Association's Immunisation Comittee plans new guidance in 2012 with a view to recommending the PCV-13 vaccine, Dr Anna-Maria Geretti of London's Royal Free and University College Medical School told aidsmap.

The PCV-13 is already licensed for use in children and is used routinely in the UK childhood vaccination programme.

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