Vaccines for children and adults with chronic lung disease: efficacy against acute exacerbations

Abstract

Acute exacerbations of chronic lung disease are usually associated with viral and bacterial pathogens. They contribute to declining lung function, poor quality of life and exert an excess burden on individuals, families, communities and the healthcare sector. Hence, preventing exacerbations is important in clinical management. Several vaccines providing protection against respiratory pathogens (Streptococcus pneumoniae, Bordetella pertussis and influenza) that can trigger exacerbations are available, but evidence to support their effectiveness in preventing exacerbations of chronic lung disease is limited. Candidate vaccines in pre-clinical or clinical development phases include those targeting Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, respiratory syncytial virus and human rhinoviruses. However, it is likely to be several years before vaccines against these pathogens are available for children and adults with chronic lung diseases. For vaccination to play an important role in managing chronic lung disease efforts need to be directed at understanding how various pathogens cause exacerbations and alter long-term lung function.

Keywords::

• acute respiratory exacerbations
• chronic lung disease
• prevention
• vaccine efficacy
• vaccines

Financial & competing interests disclosure

K-AF O’Grady is supported by a Queensland Government Smart Futures Fellowship (51008) and a NHMRC Career Development Award (1045157). AB Chang is supported by a NHMRC Practitioner Fellowship (545216). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Acute respiratory exacerbations, most commonly triggered by infections, are associated with declining lung function in children and adults with chronic lung disease.

• Preventing exacerbations would be an important contribution to clinical management and would reduce the burden of disease and associated individual, societal and health sector costs.

• Licensed vaccines are now available for several pathogens that have been associated with respiratory exacerbations in people with chronic lung disease. These include Streptococcus pneumoniae, Bordetella pertussis and influenza virus. However, the evidence to support the role of these vaccines in preventing acute exacerbations of chronic lung disease is lacking.

• Potential vaccines in pre-clinical or clinical development phases include those targeting Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, respiratory syncytial virus and human rhinoviruses. With the possible exception of H. influenzae vaccines, evidence to support the role of these other vaccines in preventing acute exacerbations is unlikely to be available in the near future.

• Effort needs to be directed at improving uptake of existing vaccines, particularly S. pneumoniae and influenza vaccines, in children and adults with chronic lung disease who are at high risk of severe morbidity and mortality from these infections.