William Schaffner, MD: Advancing Pneumococcal Vaccine Practice
AUGUST 16, 2019
William Schaffner, MD
In the second part of an interview with MD Mag, Schaffner, a professor of Preventive Medicine in the Department of Health Policy at Vanderbilt University Medical Center, broke down the current impact of pneumococcal bacteria prevention measures—and what the future of care may hold in the field.
MD Mag: Is there hope for improved vaccines for pneumococcal bacteria, or is this the optimized vaccine?
Schaffner: Looking into the future, there are a number of companies that are developing expanded conjugate vaccines. There’s a PCV15 which we think is on the horizon—and beyond that, a PCV20 and even more. Should over the next 3-4 years those vaccines become available, they obviously will play a larger role in adult vaccination, and perhaps down the road, even eliminate the need for 2 vaccines.
Having 2 vaccines is, frankly, very confusing. Patients don’t know which one they receive. The vaccines registries, for the most part, are not comprehensive when it comes to vaccinations. And so, internists and family doctors are often relatively unsure if they haven’t cared for a patient for many years, and they’re unsure about vaccination histories.
Everyone, down the road, would love for there to be just 1 pneumococcal vaccine, as it would clarify things terrifically.
MD Mag: Could you elaborate on the disparities in childhood and adulthood cases which would require different vaccination strategy?
Schaffner: The use of PCV13 in children and adolescents has been comprehensive, and extraordinarily successful. As I said, it’s had this indirect effect of protecting adults even though they have not been effectively vaccinated. Nonetheless, there are many adults with underlying conditions or who are immunocompromised who are clearly at increased risk of invasive pneumococcal infection. And in adults, invasive disease still carries—despite effective treatment—a notable mortality rate.
The mortality rates are around 15% to 20%, and people who recover from those illnesses can have extensive disabilities. Invasive pneumococcal disease continues to be a nasty condition. That’s why the ACIP continues to recommend people in this rather long, cumbersome list of underlying conditions or with immunocompromise risk receive their own vaccine. They should be vaccinated to directly assure they will be protected.
MD Mag: Is there any model in infectious disease preventive care which can be emulated for progressing fields like pneumococcal vaccination?
Schaffner: Of course, we’ve had a great deal of vaccines that have been applied to prevention of an array of infectious and communicable disease. The whole childhood immunization program has been extraordinarily successful, and almost literally eliminated many of these diseases from our entire community.
Diphtheria, neonatal tetanus, influenza B, meningitis—all of these diseases that I grew up with that were a scourge in pediatric practice. It’s only recently we started to have some vaccines that approach that kind of effectiveness in the prevention of vaccine in adults. Pneumococcal vaccine is one of those. Another recent one—Shingrix, for shingles—looks to be comparably affected.
So, we’re beginning to apply the concept of universal or near-universal vaccination in adults the way we have in children: with the hope certain disease can be essentially eliminated from our communities.
We need to structure our immunization programs as effectively for adults as we have for children. That includes making sure every adult has vaccines available to them, whether it’s through private or public insurance programs. We’re not there yet. We essentially do have that for childhood immunizations.
That would, as I see it, be a very important next step forward in preventive health services that would really help eliminate diseases for adults.