The Joint Committee on Vaccination and Immunisation (JCVI) has issued advice (PDF) that the routine pneumococcal vaccination programme for adults aged 65 years and older should be discontinued. This advice has also been the subject of a letter from the Department of Health that aims to provide information to help clinicians answer questions from patients.
The 23 valent pneumococcal polysaccharide vaccine was introduced in 2003 with the aim of reducing the incidence of invasive pneumococcal disease in the population aged 65 years and older. At the time it was noted that the effectiveness and duration of cover was uncertain.
A recent review has found no discernable decrease in the incidence of invasive pneumococcal disease in those aged 65 years and older following the introduction of the vaccination programme despite widespread use in this age group. It is additionally noted that since the introduction of a different pneumococcal vaccine into the childhood immunisation programme in 2006 there has been a decline.
JCVI have therefore recommended that the routine pneumococcal vaccination programme for those aged 65 years and older be discontinued but the vaccine should still be offered to those in clinical risk groups as the evidence on efficacy in younger people is more robust.
The Department of Health are seeking the views of professional and patient groups and the vaccine manufacturers before making a final decision.
Action: Clinicians should be aware of this advice and the Department of Health review. In the meantime, clinicians should continue to follow the existing guidance in the Green Book.
The National Institute of Health and Clinical Excellence has published new guidance for the month of March 2011. This month there are two public health guidelines, one clinical guideline, and one technology appraisal that impact upon primary care.
The public health guidelines both relate to increasing HIV testing uptake in black Africans and men who have sex with men.
The clinical guideline discusses the diagnosis and treatment of active and latent tuberculosis in adults and children and strategies to prevent the spread of tuberculosis.
The technology appraisal is an update to a previous appraisal for the drug treatment of Alzheimer's disease. The review covers donepezil, galantamine, rivastigmine and memantine. Key changes in the update are that donepezil, galantamine and rivastigmine are now recommended in mild as well as moderate disease and memantine is now an option in moderate disease.
Action: Clinicians should be aware of these recommendations and implement any necessary changes to practice.
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