Environmental factors which can affect the burden of pneumococcal disease and the immune response to pneumococcal vaccines: the need for more precisely delineated vaccine recommendations

ABSTRACT

Introduction: Precision medicine describes the customization of healthcare tailored to the individual patient. Generally, vaccines are considered as public health tools rather than from the individual patient perspective. However, adult vaccination programs in particular should consider many different factors, at the individual level and also from societal, cultural and country-specific perspectives. Currently, most immunization programs, including those for pneumococcal vaccines, have only been adopted on the basis of age or medical risk.

Areas covered: Based on a broad literature search, this review addresses possible environmental factors which can affect the burden of pneumococcal disease and the immune response to pneumococcal vaccines.

Expert opinion: Factors which influence the incidence of pneumococcal disease and the reaction against pneumococcal vaccination, including personal conditions, geographic/ethnic factors and social risks, are diverse. To maximize the effects of pneumococcal vaccination, not only for public health but also to induce optimal effects at the individual level, vaccines need to be verified under diverse situations and with collaboration among relevant medical societies, governments, and the pharmaceutical industry. Whereas vaccines are generally considered only from the public health perspective, flexible, comprehensive and tailored pneumococcal immunization programs, with appropriate policy support, can generate a greater positive impact on public health.

KEYWORDS:

• Environmental factors
• PCV13
• pneumococcal vaccine
• pneumovax
• PPSV23
• prevnar

Article highlights

• Vaccines are generally considered as public health tools rather than from the individual patient perspective, with most immunization programs, including those for pneumococcal vaccines, being adopted only on the basis of age or medical risk.

• Adult vaccination programs, in particular, should consider many different factors, at the individual level and also from societal, cultural and country-specific perspectives.

• Currently, there are two types of pneumococcal vaccine for adults, PPSV23 (a 23-valent pneumococcal polysaccharide vaccine) and PCV13 (a 13-valent pneumococcal conjugate vaccine), each with its own advantages and disadvantages.

• Environmental factors which can affect the burden of pneumococcal disease and have an impact on the effectiveness of pneumococcal vaccination include personal conditions (e.g. from infants to adults to the elderly, and from chronic disease to immunocompromised conditions), geographic and ethnic factors (e.g. population density, ethnicity, poverty), and social risks (e.g. closed settings, occupation).

• Immunization in adults differs quite markedly from infant vaccination programs, with the majority of vaccination programs for infants being age-based and covering all individuals. However, at least for adult vaccination programs, all other factors which can affect disease burden and the reaction to the vaccine should be considered carefully.

• Flexible, comprehensive and tailored pneumococcal immunization programs, with the support of appropriate policy, can generate a greater positive impact on public health.

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Acknowledgments

Under the direction of the authors, medical writing assistance was provided by David P. Figgitt, ISMPP CMPP™, Content Ed Net, with funding from Pfizer Pharmaceuticals Korea Ltd., Seoul, Republic of Korea.

Declaration of interest

SB Park and HJ Kim are full-time employees of Pfizer Pharmaceuticals Korea Ltd. HJ Cheong did not receive any funding support from Pfizer for the conduct of this study and declares no conflict of interest. All authors were involved in concept generation, reviewing the literature, drafting the manuscript, approval of the final version, and the decision to submit the manuscript for publication.

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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

A reviewer of this manuscript declares receiving grant funding from Merck & Co. Inc. and Pfizer. Another reviewer of this manuscript declares receiving honorarium from Pfizer, GlaxoSmithKline and Merck for advisory boards on pneumococcal vaccines as well as receiving funding from Pfizer and Merck for a project related to Streptococcus pneumoniae. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

The manuscript was supported by Pfizer Pharmaceuticals Korea Ltd., Seoul, Republic of Korea.