Yıl: 2018 Cilt: 31 Sayı: suppl 1 Sayfa Aralığı: 2 - 18 Metin Dili: Türkçe DOI: 10.5152/kd.2018.2 İndeks Tarihi: 26-07-2019

Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu

Öz:
Pnömokok hastalıkları, bakteriyemik olan ya da olmayan pnömonibaşta olmak üzere, özellikle yaşlılarda ve immün sistemi zayıflatandurumlar gibi birtakım sağlık sorunları olan erişkinlerde, tümdünyada önemli bir morbidite ve mortalite nedeni olmaya devametmektedir. Ülkemizde 13 valan konjuge pnömokok aşısı (KPA13)ve 23 valan polisakarid pnömokok aşısı (PPA23) olmak üzere erişkinleriçin ruhsatlandırılmış iki aşı vardır. PPA23 erişkinlerde yıllardırkullanılmaktadır. 2008’de 7 valan konjuge pnömokok aşısı(KPA7) çocuklarda kullanılmak üzere Genişletilmiş BağışıklamaProgramı’na alınmıştır; daha sonra 2011’de KPA7 yerini KPA13’ebırakmıştır. Yakınlarda Sağlık Bakanlığı’nca, Bağışıklama DanışmaKurulu kararları doğrultusunda, aşıyla önlenebilir hastalıklar açısındanrisk grupları kabul edilmiş ve bunlara uygulanması gereken,aralarında erişkinlerde pnömokok aşılamasının da bulunduğu aşışemaları yürürlüğe konulmuştur. Bu şemalar, pnömokok aşıları yönünden,KPA13’ün hem yüksek risk altındaki erişkinlere hem de≥65 yaşındaki tüm erişkinlere uygulanması gibi ABD’deki güncelAdvisory Committee on Immunization Practices (ACIP) önerileriylebüyük ölçüde örtüşmektedir. Ayrıca, yakınlarda yayımlanan birgenelgeyle ülkemizde de başlatılacağı açıklanan invazif pnömokokhastalıkları sürveyansı, Aşıyla Önlenebilir İnvazif Bakteriyel HastalıklarınSürveyansı programının kapsamına alınmıştır. Türk KlinikMikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin BağışıklamasıÇalışma Grubu’nca hazırlanan bu uzlaşı raporunda ilgili lite-ratür ve uluslararası öneriler gözden geçirilmiş ve üzerinde uzlaşılanöneriler sunulmuştur. Bu önerilerden seçilmiş birkaçı aşağıdasıralanmıştır: [1] ≥65 yaşındaki herkese, yüksek risk altındaki heryaştan erişkinler (yani immün sistemi zayıflatan durumu, fonksiyonelya da anatomik asplenisi, beyin-omurilik sıvısı kaçağı ve kokleaimplantı olan hastalar) gibi, önce KPA13 ve sonra PPA23 uygulanmalıdır.[2] Pnömokok aşılaması, pnömokok hastalığı yönündenrisk altında olan (yani kronik kalp hastalığı, kronik akciğer hastalığı,kronik karaciğer hastalığı, alkolizm, diabetes mellitus’u olan hastalarve tütün kullananlar gibi) <65 yaşındaki erişkinler için de önerilir.Bu hastalara yalnız PPA23 uygulanması yeterlidir; ancak PPA23öncesinde KPA13 uygulanması da yararlı olabilir. [3] Her iki aşınınuygulanmasının gerektiği erişkinlere önce KPA13 uygulanmalıdır.[4] PPA23’ün, immünokompetan erişkinlerin çoğuna KPA13’ten ≥1yıl sonra uygulanmasına karşın; bu aşı yüksek riskli hastalara ≥8hafta sonra uygulanmalıdır. [5] Daha önce PPA23 uygulanmış hastalara,bu uygulamanın üzerinden ≥1 yıl geçmeden KPA13 uygulanmamalıdır.[6] İmmün sistemi zayıflamış ve asplenik hastalaraPPA23’ün ilk dozundan ≥5 yıl sonra bir rapel dozu da uygulanmalıdır.[7] KPA13 için hiçbir yaş grubunda rapel dozu önerilmemektedir.[8] Her iki aşı da farklı bir bölgeye uygulanmak koşuluyla gripaşısıyla aynı anda yapılabilir. [9] Çocukluk çağı bağışıklamasındakullanılan KPA13, toplumdaki aşı suşlarını ortadan kaldırabildiğiiçin, bu aşı erişkinlerde beklenen yararı sürekli olarak sağlamayabilir.Bu nedenle, serotip dağılımı ve antibiyotik direnci hızları dadahil olmak üzere lokal epidemiyolojinin anlaşılması için erişkinpnömokok hastalıklarının sürveyansı son derecede önemlidir.
Anahtar Kelime:

Konular: Mikrobiyoloji Enfeksiyon Hastalıkları

Pneumococcal Vaccine as One of the Immunization Coverage Targets for Adulthood Vaccines: A Consensus Report of the Study Group for Adult Immunization of the Turkish Society of Clinical Microbiology and Infectious Diseases

Öz:
Pneumococcal diseases, including pneumonia with or without bacteremia, remain an important cause of morbidity and mortality in adults, especially among the elderly and those with certain medical conditions, including immunocompromising conditions all over the world. Two pneumococcal vaccines are currently licensed for adults in Turkey, 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23). PPSV23 has been available for many years for use in adults. A 7-valent pneumococcal conjugate vaccine (PCV7) included in the Expanded Programme on Immunization for use in infants and children in 2008, and thereafter PCV13 replaced PCV7 in 2011. Recently, the Ministry of Health of Turkey accepted risk groups for vaccine-preventable diseases, and implemented their immunization schedules in accordance with the decisions of Immunization Advisory Committee, including adult pneumococcal vaccination greatly compatible with those of updated U.S. Advisory Committee on Immunization Practices (ACIP) recommendations such as PCV13 for selected high-risk adults and for all adults ≥65 years of age. Furthermore, surveillance of invasive pneumococcal disease has already been included as part of the Surveillance of Vaccine-Preventable Invasive Bacterial Diseases announced that would be started soon in Turkey. In this consensus report prepared by Study Group for Adult Immunization of the Turkish Society of Clinical Microbiology and Infectious Diseases, relevant literature and international recommendations were reviewed, and recommendations agreed are presented. Examples of some selected recommendations are as follows: [1] All individuals aged ≥65 years should receive PCV13 followed by PPSV23, as well as adults of any age with the high-risk conditions (ie, patients with an immunocompromising condition, functional or anatomic asplenia, a cerebrospinal fluid leak, and a cochlear implant). [2] Pneumococcal vaccination is also recommended for adults <65 years of age at risk of pneumococcal diseases (ie, patients with chronic heart disease, chronic lung disease, chronic liver disease, alcoholism, diabetes mellitus, and smokers). Such patients receive PPSV23 alone; however, PCV13 followed by PPSV 23 could be useful as well. [3] Adults eligible for both vaccines should be given PCV13 first. [4] Even though PPSV23 is administered ≥1 year after PCV13 for most immunocompetent adults, it should be administered ≥8 weeks later for high-risk patients. [5] In patients who have already received PPSV23, ≥1 year should elapse before they are given PCV13. [6] For immunocompromised and asplenic patients, a booster dose of PPSV23 is recommended ≥5 years after the first dose. [7] A booster dose of PCV13 is not recommended for any age group. [8] Both vaccines may be administered concurrently with influenza vaccine, but at a separate site. [9] Use of PCV13 in adults may not always provide expected benefit because of the trend for vaccine strains to disappear from the population following childhood immunization with same vaccine. Therefore, surveillance for adult pneumococcal diseases is highly important to understand local epidemiology including serotype distribution and antibiotic resistance rates.
Anahtar Kelime:

Konular: Mikrobiyoloji Enfeksiyon Hastalıkları
Belge Türü: Makale Makale Türü: Diğer Erişim Türü: Erişime Açık
  • 1. Vila-Corcoles A, Ochoa-Gondar O. Preventing pneumococcal disease in the elderly: recent advances in vaccines and implications for clinical practice. Drugs Aging. 2013; 30(5): 263-76. [CrossRef]
  • 2. Torres A, Bonanni P, Hryniewicz W, Moutschen M, Reinert RR, Welte T. Pneumococcal vaccination: what have we learnt so far and what can we expect in the future? Eur J Clin Microbiol Infect Dis. 2015; 34(1): 19-31. [CrossRef]
  • 3. Castiglia P. Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe. Adv Ther. 2014; 31(10): 1011-44. [CrossRef]
  • 4. Chavanet P. Pneumococcus infections: is the burden still as heavy? Med Mal Infect. 2012; 42(4): 149-53. [CrossRef]
  • 5. José RJ, Brown JS. Adult pneumococcal vaccination: advances, impact, and unmet needs. Curr Opin Pulm Med. 2017; 23(3): 225-30. [CrossRef]
  • 6. Cillóniz C, Amaro R, Torres A. Pneumococcal vaccination. Curr Opin Infect Dis. 2016; 29(2): 187-96. [CrossRef]
  • 7. Drijkoningen JJ, Rohde GG. Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect. 2014; 20 (Suppl. 5): 45- 51. [CrossRef]
  • 8. Aliberti S, Mantero M, Mirsaeidi M, Blasi F. The role of vaccination in preventing pneumococcal disease in adults. Clin Microbiol Infect. 2014; 20(Suppl. 5):52-8. [CrossRef]
  • 9. Chidiac C. Pneumococcal infections and adult with risk factors. Med Mal Infect. 2012; 42(10): 517-24. [CrossRef]
  • 10. Durando P, Faust SN, Fletcher M, Krizova P, Torres A, Welte T. Experience with pneumococcal polysaccharide conjugate vaccine (conjugated to CRM197 carrier protein) in children and adults. Clin Microbiol Infect. 2013; 19(Suppl. 1): 1-9. [CrossRef]
  • 11. Berical AC, Harris D, Dela Cruz CS, Possick JD. Pneumococcal vaccination strategies. An update and perspective. Ann Am Thorac Soc. 2016; 13(6): 933-44. [CrossRef]
  • 12. Grabenstein JD, Musher DM. Pneumococcal polysaccharide vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin’s Vaccines. Seventh ed. Philadelphia, PA: Elsevier, 2018: 816-40. [CrossRef]
  • 13. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015; 373(5): 415-27. [CrossRef]
  • 14. Blasi F, Mantero M, Santus P, Tarsia P. Understanding the burden of pneumococcal disease in adults. Clin Microbiol Infect. 2012; 18(Suppl. 5): 7-14. [CrossRef]
  • 15. Pallotta A, Rehm SJ. Navigating pneumococcal vaccination in adults. Cleve Clin J Med. 2016; 83(6): 427-33. [CrossRef]
  • 16. Sanford M. Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed): in older adults. Drugs. 2012; 72(9): 1243-55. [CrossRef]
  • 17. Sings HL. Pneumococcal conjugate vaccine use in adults - Addressing an unmet medical need for non-bacteremic pneumococcal pneumonia. Vaccine. 2017; 35(40): 5406-17. [CrossRef]
  • 18. Isturiz RE, Schoemele-Thoma B, Scott DA, et al. Pneumococcal conjugate vaccine use in adults. Expert Rev Vaccines. 2016; 15(3): 279-92.
  • 19. Pneumococcal vaccines WHO position paper--2012. Wkly Epidemiol Rec. 2012; 14(87): 129-44.
  • 20. Aşıyla Önlenebilir Hastalıklar Daire Başkanlığı. Aşı İle Önlenebilir İnvaziv Bakteriyel Hastalıklar Sürveyansı Genelgesi. 15.12. 2016 Tarih ve 21001706/131.12 Sayı. Ankara: Türkiye Halk Sağlığı Kurumu, 2016.
  • 21. Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012; 61(40): 816-9.
  • 22. Papadatou I, Spoulou V. Pneumococcal vaccination in high-risk individuals: are we doing it right? Clin Vaccine Immunol. 2016; 23(5): 388-95. [CrossRef]
  • 23. Imai K, Petigara T, Kohn MA, et al. Risk of pneumococcal diseases in adults with underlying medical conditions: a retrospective, cohort study using two Japanese healthcare databases. BMJ Open. 2018; 8(3): e018553.
  • 24. Kim DK, Riley LE, Hunter P. Recommended immunization schedule for adults aged 19 years or older, United States, 2018. Ann Intern Med. 2018; 168(3): 210-20. [CrossRef]
  • 25. Shea KM, Edelsberg J, Weycker D, Farkouh RA, Strutton DR, Pelton SI. Rates of pneumococcal disease in adults with chronic medical conditions. Open Forum Infect Dis. 2014; 1(1):ofu024. [CrossRef]
  • 26. Pelton SI, Shea KM, Weycker D, Farkouh RA, Strutton DR, Edelsberg J. Rethinking risk for pneumococcal disease in adults: the role of risk stacking. Open Forum Infect Dis. 2015;2(1): ofv020. [CrossRef]
  • 27. Curcio D, Cané A, Isturiz R. Redefining risk categories for pneumococcal disease in adults: critical analysis of the evidence. Int J Infect Dis. 2015; 37: 30-5. [CrossRef]
  • 28. Morton JB, Morrill HJ, LaPlante KL, Caffrey AR. Risk stacking of pneumococcal vaccination indications increases mortality in unvaccinated adults with Streptococcus pneumoniae infections. Vaccine. 2017; 35(13): 1692-7. [CrossRef]
  • 29. Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax. 2015; 70(10): 984-9. [CrossRef]
  • 30. Doruk S, Tertemiz KC, Kömüs N, Uçan ES, Kilinç O, Sevinç C. Community acquired pneumonia and direct hospital cost. Tüberk Toraks. 2009; 57(1): 48-55.
  • 31. Kosar F, Alici DE, Hacibedel B, Arpınar Yigitbas B, Golabi P, Cuhadaroglu C. Burden of community-acquired pneumonia in adults over 18 y of age. Human Vaccin Immunother. 2017; 13(7): 1673-80. [CrossRef]
  • 32. Lynch JP 3rd, Zhanel GG. Streptococcus pneumoniae: does antimicrobial resistance matter? Semin Respir Crit Care Med. 2009; 30(2):210-38. [CrossRef]
  • 33. Lynch JP 3rd, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med. 2010; 16(3): 217-25. [CrossRef]
  • 34. Song JH, Dagan R, Klugman KP, Fritzell B. The relationship between pneumococcal serotypes and antibiotic resistance. Vaccine. 2012; 30(17): 2728-37. [CrossRef]
  • 35. Hasçelik G, Gürler N, Ceyhan M, et al. Serotype distribution and antibiotic resistance among isolates of Streptococcus pneumoniae causing invasive pneumococcal disease in adults in Turkey: 2005-2015. Poster Presented at 17th International Congress on Infectious Diseases (2-5 March 2016, Hyderabad, India) [İnternet]. London: F1000 Research Ltd. [erişim 21 Ocak 2018]. https:// f1000research.com/posters/5-546.
  • 36. Yildirim I, Shea KM, Pelton SI. Pneumococcal disease in the era of pneumococcal congugate vaccine. Infect Dis Clin Am North Am. 2015; 29(4): 679-97. [CrossRef]
  • 37. Musher DM. Pneumococcal vaccination in adults [İnternet]. Waltham, MA: UpToDate, Inc. [erişim 21 Ocak 2018]. https://www.uptodate. com/contents/pneumococcal-vaccination-in-adults. 38. Gentile A, Bazán V. Prevention of pneumococcal disease through vaccination. Vaccine. 2011; 29(Suppl. 3): C15-25. [CrossRef]
  • 39. Tromp KM, Campbell MW, Vazquez A. Recent developments and future directions of pneumococcal vaccine recommendations. Clin Ther. 2015; 37(5): 928-34. [CrossRef]
  • 40. Advisory Committee on Immunization Practices. Preventing pneumococcal disease among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2000; 49(RR-9): 1-35.
  • 41. Pebody RG, Leino T, Nohynek H, Hellenbrand W, Salmaso S, Ruutu P. Pneumococcal vaccination policy in Europe. Euro Surveill. 2005; 10(9): 174-8. [CrossRef]
  • 42. Pilishvili T, Bennett NM. Pneumococcal disease prevention among adults: strategies for the use of pneumococcal vaccines. Vaccine. 2015; 33(Suppl. 4): D60-5. [CrossRef]
  • 43. Musher DM. How effective is vaccination in preventing pneumococcal disease? Infect Dis Clin North Am. 2013; 27(1): 229-41. [CrossRef]
  • 44. 23-valent pneumococcal polysaccharide vaccine. WHO position paper. Wkly Epidemiol Rec. 2008; 83(42): 373-84.
  • 45. Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2013; (1): CD000422. [CrossRef]
  • 46. Musher DM, Rueda-Jaimes AM, Graviss EA, Rodriguez-Barradas MC. Effect of pneumococcal vaccination: a comparison of vaccination rates in patients with bacteremic and nonbacteremic pneumococcal pneumonia. Clin Infect Dis. 2006;43(8):1004-8. [CrossRef]
  • 47. Ochoa-Gondar O, Vila-Corcoles A, Rodriguez-Blanco T, et al. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged ≥60 years: 3 years of follow-up in the CAPAMIS study. Clin Infect Dis. 2014; 58(7): 909-17. [CrossRef]
  • 48. Suzuki M, Dhoubhadel BG, Ishifuji T, et al. Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study. Lancet Infect Dis. 2017; 17(3): 313-21. [CrossRef]
  • 49. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med. 1991; 325(21): 1453-60. [CrossRef]
  • 50. Schiffner-Rohe J, Witt A, Hemmerling J, von Eiff C, Leverkus FW. Efficacy of PPV23 in preventing pneumococcal pneumonia in adults at increased risk - A systematic review and meta-analysis. PLoS One. 2016; 11(1): e0146338. [CrossRef]
  • 51. French N, Nakiyingi J, Carpenter LM, et al. 23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double-blind, randomised and placebo controlled trial. Lancet. 2000; 355(9221): 2106-11. [CrossRef]
  • 52. Blanchard-Rohner G, Pollard AJ. Long-term protection after immunization with protein-polysaccharide conjugate vaccines in infancy. Expert Rev Vaccines. 2011; 10(5): 673-84. [CrossRef]
  • 53. Romero-Steiner S, Musher DM, Cetron MS, et al. Reduction in functional antibody activity against Streptococcus pneumoniae in vaccinated elderly individuals highly correlates with decreased IgG antibody avidity. Clin Infect Dis. 1999; 29(2): 281-8. [CrossRef]
  • 54. Musher DM, Manoff SB, Liss C, et al. Safety and antibody response, including antibody persistence for 5 years, after primary vaccination or revaccination with pneumococcal polysaccharide vaccine in middle-aged and older adults. J Infect Dis. 2010; 201(4):516-24. [CrossRef]
  • 55. Musher DM, Sampath R, Rodriguez-Barradas MC. The potential role for protein-conjugate pneumococcal vaccine in adults: what is the supporting evidence? Clin Infect Dis. 2011; 52(5): 633-40. [CrossRef]
  • 56. Musher DM, Manoff SB, McFetridge RD, et al. Antibody persistence ten years after first and second doses of 23-valent pneumococcal polysaccharide vaccine, and immunogenicity and safety of second and third doses in older adults. Hum Vaccin. 2011; 7(9): 919-28. [CrossRef]
  • 57. Grabenstein JD, Manoff SB. Pneumococcal polysaccharide 23-valent vaccine: long-term persistence of circulating antibody and immunogenicity and safety after revaccination in adults. Vaccine. 2012; 30(30): 4435-44. [CrossRef]
  • 58. Clutterbuck EA, Lazarus R, Yu LM, et al. Pneumococcal conjugate and plain polysaccharide vaccines have divergent effects on antigen- specific B cells. J Infect Dis. 2012; 205(9):1408-16. [CrossRef]
  • 59. Temel Sağlık Hizmetleri Genel Müdürlüğü. Genişletilmiş Bağışıklama Programı Genelgesi. 13.03.2009 Tarih ve 7941-2009/17 Sayı. Ankara: Sağlık Bakanlığı, 2009.
  • 60. Grabenstein JD, Weber DJ. Pneumococcal serotype diversity among adults in various countries, influenced by pediatric pneumococcal vaccination uptake. Clin Infect Dis. 2014; 58(6): 854-64. [CrossRef]
  • 61. Zangeneh TT, Baracco G, Al-Tawfiq JA. Impact of conjugate pneumococcal vaccines on the changing epidemiology of pneumococcal infections. Expert Rev Vaccines. 2011; 10(3): 345-53. [CrossRef]
  • 62. Özkan S, Ceyhan M. Ulusal Aşı Çalıştayı (27-29 Mart 2014, Ankara) Raporu. Ankara: Sağlık Bakanlığı ve Enfeksiyon Hastalıkları Derneği, 2014.
  • 63. Plosker GL. 13-valent pneumococcal conjugate vaccine: a review of its use in adults. Drugs. 2015; 75(13): 1535-46. [CrossRef]
  • 64. Jackson LA, Gurtman A, van Cleeff M, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults. Vaccine. 2013; 31(35): 3577-84. [CrossRef]
  • 65. Ewald H, Briel M, Vuichard D, Kreutle V, Zhydkov A, Gloy V. The clinical effectiveness of pneumococcal conjugate vaccines: a systematic review and meta-analysis of randomized controlled trials. Dtsch Arztebl Int. 2016; 113(9): 139-46. [CrossRef]
  • 66. Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014; 63(37): 822-5.
  • 67. Dagan R, Poolman J, Siegrist CA. Glycoconjugate vaccines and immune interference: a review. Vaccine. 2010; 28(34): 5513–23. [CrossRef]
  • 68. Frenck RW Jr, Gurtman A, Rubino J, et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012; 19(8): 1296-303. [CrossRef]
  • 69. Schwarz TF, Flamaing J, Rümke HC, et al. A randomized, doubleblind trial to evaluate immunogenicity and safety of 13-valent pneumococcal conjugate vaccine given concomitantly with trivalent influenza vaccine in adults aged ≥65 years. Vaccine. 2011; 29(32): 5195-202. [CrossRef]
  • 70. Schwarz TF, Schmoele-Thoma B. Assessment of functional antibacterial opsonophagocytic antibodies elicited by 13-valent pneumococcal conjugate vaccine administered concomitantly with trivalent influenza vaccine in a randomized clinical trial in adults aged ≥65 years. Vaccine. 2013; 31(2): 291-4. [CrossRef]
  • 71. Bonten MJ, Huijts SM, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015; 372(12): 1114-25. [CrossRef]
  • 72. van Werkhoven CH, Bonten MJ. The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA): what is the future of pneumococcal conjugate vaccination in elderly? Future Microbiol. 2015;10(9): 1405-13. [CrossRef]
  • 73. Öksüz L, Gürler N. Bir üniversite hastanesinde yetişkin hastalardan izole edilen Streptococcus pneumoniae suşlarının serotip dağılımı ve antibiyotik direnci. Mikrobiyol Bül. 2017; 51(3): 195-208. [CrossRef]
  • 74. Isturiz RE, Hall-Murray C, McLaughlin JM, et al. Pneumococcal conjugate vaccine use for the prevention of pneumococcal disease in adults <50 years of age. Expert Rev Vaccines. 2018; 17(1): 45-55.
  • 75. Hochman M, Cohen PA. Reconsidering guidelines on the use of pneumococcal vaccines in adults 65 years or older. JAMA Intern Med. 2015; 175(12): 1895-6. [CrossRef]
  • 76. Musher DM, Rodriguez-Barradas MB. Why the recent ACIP recommendations regarding conjugate pneumococcal vaccine in adults may be irrelevant. Hum Vaccin Immunother. 2016; 12(2): 331-5. [CrossRef]
  • 77. van Werkhoven CH, Huijts SM, Bolkenbaas M, et al. The impact of age on the efficacy of 13-valent pneumococcal conjugate vaccine in elderly. Clin Infect Dis. 2015; 61(12): 1835-8. [CrossRef]
  • 78. Huijts SM, van Werkhoven CH, Bolkenbaas M, Grobbee DE, Bonten MJM. Post-hoc analysis of a randomized controlled trial: Diabetes mellitus modifies the efficacy of the 13-valent pneumococcal conjugate vaccine in elderly. Vaccine. 2017; 35(34): 4444-9. [CrossRef]
  • 79. van Deursen AMM, van Houten MA, Webber C, et al. Immunogenicity of the 13-valent pneumococcal conjugate vaccine in older adults with and without comorbidities in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Clin Infect Dis. 2017; 65(5): 787-95. [CrossRef]
  • 80. Suaya JA, Jiang Q, Scott DA, et al. Post hoc analysis of the efficacy of the 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia in at-risk older adults. Vaccine. 2018; 36(11): 1477-83. [CrossRef]
  • 81. Kobayashi M, Bennett NM, Gierke R, et al. Intervals between PCV13 and PPSV23 vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2015; 64(34): 944-7. [CrossRef]
  • 82. Musher DM, Rueda AM, Nahm MH, Graviss EA, Rodriguez-Barradas MC. Initial and subsequent response to pneumococcal polysaccharide and protein-conjugate vaccines administered sequentially to adults who have recovered from pneumococcal pneumonia. J Infect Dis. 2008; 198(7): 1019-27. [CrossRef]
  • 83. Goldblatt D, Southern J, Andrews N, et al. The immunogenicity of 7-valent pneumococcal conjugate vaccine versus 23-valent polysaccharide vaccine in adults aged 50-80 years. Clin Infect Dis. 2009; 49(9): 1318-25. [CrossRef]
  • 84. Jackson LA, Gurtman A, van Cleeff M, et al. Influence of initial vaccination with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine on anti-pneumococcal responses following subsequent pneumococcal vaccination in adults 50 years and older. Vaccine. 2013; 31(35): 3594-602. [CrossRef]
  • 85. Greenberg RN, Gurtman A, Frenck RW, et al. Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naïve adults 60-64 years of age. Vaccine. 2014; 32(20): 2364-74. [CrossRef]
  • 86. Lazarus R, Clutterbuck E, Yu LM, et al. A randomized study comparing combined pneumococcal conjugate and polysaccharide vaccination schedules in adults. Clin Infect Dis. 2011; 52(6): 736-42. [CrossRef]
  • 87. Frenck RW Jr, Figuet A, Gurtman A, et al. Immunogenicity and safety of a second administration of 13-valent pneumococcal conjugate vaccine 5 years after initial vaccination in adults 50 years and older. Vaccine. 2016; 34(30): 3454-62. [CrossRef]
  • 88. Macintyre CR, Ridda I, Gao Z, et al. A randomized clinical trial of the immunogenicity of 7-valent pneumococcal conjugate vaccine compared to 23-valent polysaccharide vaccine in frail, hospitalized elderly. PLoS One. 2014; 9(4): e94578. [CrossRef]
  • 89. de Roux A, Schmöele-Thoma B, Siber GR, et al. Comparison of pneumococcal conjugate polysaccharide and free polysaccharide vaccines in elderly adults: conjugate vaccine elicits improved antibacterial immune responses and immunological memory. Clin Infect Dis. 2008; 46(7): 1015-23. [CrossRef]
  • 90. Jackson LA, Gurtman A, Rice K, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine. 2013; 31(35): 3585-93. [CrossRef]
  • 91. O’Brien KL, Hochman M, Goldblatt D. Combined schedules of pneumococcal conjugate and polysaccharide vaccines: is hyporesponsiveness an issue? Lancet Infect Dis. 2007; 7(9): 597-606. [CrossRef]
  • 92. Manoff SB, Liss C, Caulfield MJ, et al. Revaccination with a 23-valent pneumococcal polysaccharide vaccine induces elevated and persistent functional antibody responses in adults aged ≥65 years. J Infect Dis. 2010; 201(4): 525-33. [CrossRef]
  • 93. Hammitt LL, Bulkow LR, Singleton RJ, et al. Repeat revaccination with 23-valent pneumococcal polysaccharide vaccine among adults aged 55-74 years living in Alaska: no evidence of hyporesponsiveness. Vaccine. 2011; 29(12): 2287-95. [CrossRef]
  • 94. Centers for Disease Control (CDC). Recommendations of the Immunization Practices Advisory Committee: Pneumococcal polysaccharide vaccine. MMWR Morb Mortal Wkly Rep. 1989; 38(5): 64-8, 73-6.
  • 95. Mourtzoukou EG, Pappas G, Peppas G, Falagas ME. Vaccination of asplenic or hyposplenic adults. Br J Surg. 2008; 95(3): 273-80. [CrossRef]
  • 96. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014; 58(3): e44-100. [CrossRef]
  • 97. Aşıyla Önlenebilir Hastalıklar Daire Başkanlığı. Risk Grubu Aşılamaları Genelgesi. 17.06.2016 Tarih ve 21001706/131.99 Sayı. Ankara: Türkiye Halk Sağlığı Kurumu, 2016.
  • 98. Porchia BR, Bonanni P, Bechini A, Bonaccorsi G, Boccalini S. Evaluating the costs and benefits of pneumococcal vaccination in adults. Expert Rev Vaccines. 2017; 16(2): 93-107. [CrossRef]
  • 99. Smith KJ, Wateska AR, Nowalk MP, Raymund M, Nuorti JP, Zimmerman RK. Cost-effectiveness of adult vaccination strategies using pneumococcal conjugate vaccine compared with pneumococcal polysaccharide vaccine. JAMA. 2012; 307(8): 804-12. [CrossRef]
  • 100. Rodríguez González-Moro JM, Menéndez R, Campins M, et al. Cost effectiveness of the 13-valent pneumococcal conjugate vaccination program in chronic obstructive pulmonary disease patients aged 50+ years in Spain. Clin Drug Investig. 2016; 36(1): 41-53. [CrossRef]
  • 101. Cho BH, Stoecker C, Link-Gelles R, Moore MR. Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions. Vaccine. 2013; 31(50): 6011-21. [CrossRef]
  • 102. Smith KJ, Nowalk MP, Raymund M, Zimmerman RK. Costeffectiveness of pneumococcal conjugate vaccination in immunocompromised adults. Vaccine. 2013; 31(37): 3950-6. [CrossRef]
  • 103. Rozenbaum MH, van Hoek AJ, Fleming D, Trotter CL, Miller E, Edmunds WJ. Vaccination of risk groups in England using the 13 valent pneumococcal conjugate vaccine: economic analysis. BMJ. 2012; 345: e6879. [CrossRef]
  • 104. Akin L, Kaya M, Altinel S, Durand L. Cost of pneumococcal infections and cost-effectiveness analysis of pneumococcal vaccination at risk adults and elderly in Turkey. Hum Vaccin. 2011; 7(4): 441-50. [CrossRef]
  • 105. Shiri T, Datta S, Madan J, et al. Indirect effects of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease: a systematic review and meta-analysis. Lancet Glob Health. 2017; 5(1): e51-9. [CrossRef]
  • 106. Tsaban G, Ben-Shimol S. Indirect (herd) protection, following pneumococcal conjugated vaccines introduction: a systematic review of the literature. Vaccine. 2017; 35(22): 2882-91. [CrossRef]
  • 107. Rodrigo C, Bewick T, Sheppard C, et al. Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia. Eur Respir J. 2015; 45(6): 1632-41. [CrossRef]
  • 108. Mendes RE, Hollingsworth RC, Costello A, et al. Noninvasive Streptococcus pneumoniae serotypes recovered from hospitalized adult patients in the United States in 2009 to 2012. Antimicrob Agents Chemother. 2015; 59(9): 5595-601. [CrossRef]
  • 109. Moore MR, Link-Gelles R, Schaffner W, et al. Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA - analysis of multisite, population-based surveillance. Lancet Infect Dis. 2015; 15(3): 301-9. [CrossRef]
  • 110. Musher DM, Roig IL, Cazares G, Stager CE, Logan N, Safar H. Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study. J Infect. 2013; 67(1): 11-8. [CrossRef]
  • 111. Hak E, Grobbee DE, Sanders EA, et al. Rationale and design of CAPITA: A RCT of 13-valent conjugated pneumococcal vaccine efficacy among older adults. Neth J Med. 2008; 66(9): 378-83.
  • 112. Rozenbaum MH, Hak E, van der Werf TS, Postma MJ. Results of a cohort model analysis of the cost-effectiveness of routine immunization with 13-valent pneumococcal conjugate vaccine of those aged ≥65 years in the Netherlands. Clin Ther. 2010; 32(8): 1517-32. [CrossRef]
  • 113. van Deursen AMM, van Houten MA, Webber C, et al. Immunogenicity of the 13-valent pneumococcal conjugate vaccine in older adults with and without comorbidities in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Clin Infect Dis. 2017; 65(5): 787-95. [CrossRef]
  • 114. Musher DM. Should 13-valent protein-conjugate pneumococcal vaccine be used routinely in adults? Clin Infect Dis. 2012; 55(2): 265-7. [CrossRef]
  • 115. French N, Gordon SB, Mwalukomo T, et al. A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults. N Engl J Med. 2010; 362(9): 812-22. [CrossRef]
  • 116. Kaplan SL, Barson WJ, Lin PL, et al. Serotype 19A is the most common serotype causing invasive pneumococcal infections in children. Pediatrics. 2010; 125(3): 429-36. [CrossRef]
  • 117. Isturiz R, Sings HL, Hilton B, Arguedas A, Reinert RR, Jodar L. Streptococcus pneumoniae serotype 19A: Worldwide epidemiology. Expert Rev Vaccines. 2017; 16(10): 1007-27. [CrossRef]
  • 118. Pilishvili T, Lexau C, Farley MM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis. 2010; 201(1): 32-41. [CrossRef]
  • 119. Corcoran M, Vickers I, Mereckiene J, et al. The epidemiology of invasive pneumococcal disease in older adults in the post- PCV era. Has there been a herd effect? Epidemiol Infect. 2017; 145(11): 2390-9. [CrossRef]
  • 120. Burns IT, Zimmerman RK. Immunization barriers and solutions. J Fam Pract. 2005; 54(1 Suppl.): S58-62.
  • 121. Kimmel SR, Burns IT, Wolfe RM, Zimmerman RK. Addressing immunization barriers, benefits, and risks. J Fam Pract. 2007; 56(2 Suppl. Vaccines): S61-9.
  • 122. Grogg SE, Schultz J. Call to action on pneumococcal disease: review of vaccination evidence and outcomes of webcast programs. J Am Osteopath Assoc. 2015; 115(6 Suppl.): S6-25.
  • 123. Ghadieh AS, Hamadeh GN, Mahmassani DM, Lakkis NA. The effect of various types of patients’ reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial. Vaccine. 2015; 33(43): 5868-72. [CrossRef]
  • 124. Dolan GP, Harris RC, Clarkson M, et al. Vaccination of healthcare workers to protect patients at increased risk of acute respiratory disease: summary of a systematic review. Influenza Other Respir Viruses. 2013; 7(Suppl. 2): 93-6. [CrossRef]
  • 125. Rosch JW. Promises and pitfalls of live attenuated pneumococcal vaccines. Hum Vaccin Immunother. 2014; 10(10): 3000-3. [CrossRef]
APA ŞENOL E, AZAP A, ERBAY A, ALP ÇAVUŞ S, Karakus R, Acar A (2018). Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. , 2 - 18. 10.5152/kd.2018.2
Chicago ŞENOL ESİN,AZAP Alpay,ERBAY Ayşe,ALP ÇAVUŞ Sema,Karakus Resul,Acar Ali Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. (2018): 2 - 18. 10.5152/kd.2018.2
MLA ŞENOL ESİN,AZAP Alpay,ERBAY Ayşe,ALP ÇAVUŞ Sema,Karakus Resul,Acar Ali Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. , 2018, ss.2 - 18. 10.5152/kd.2018.2
AMA ŞENOL E,AZAP A,ERBAY A,ALP ÇAVUŞ S,Karakus R,Acar A Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. . 2018; 2 - 18. 10.5152/kd.2018.2
Vancouver ŞENOL E,AZAP A,ERBAY A,ALP ÇAVUŞ S,Karakus R,Acar A Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. . 2018; 2 - 18. 10.5152/kd.2018.2
IEEE ŞENOL E,AZAP A,ERBAY A,ALP ÇAVUŞ S,Karakus R,Acar A "Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu." , ss.2 - 18, 2018. 10.5152/kd.2018.2
ISNAD ŞENOL, ESİN vd. "Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu". (2018), 2-18. https://doi.org/10.5152/kd.2018.2
APA ŞENOL E, AZAP A, ERBAY A, ALP ÇAVUŞ S, Karakus R, Acar A (2018). Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. Klimik Dergisi, 31(suppl 1), 2 - 18. 10.5152/kd.2018.2
Chicago ŞENOL ESİN,AZAP Alpay,ERBAY Ayşe,ALP ÇAVUŞ Sema,Karakus Resul,Acar Ali Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. Klimik Dergisi 31, no.suppl 1 (2018): 2 - 18. 10.5152/kd.2018.2
MLA ŞENOL ESİN,AZAP Alpay,ERBAY Ayşe,ALP ÇAVUŞ Sema,Karakus Resul,Acar Ali Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. Klimik Dergisi, vol.31, no.suppl 1, 2018, ss.2 - 18. 10.5152/kd.2018.2
AMA ŞENOL E,AZAP A,ERBAY A,ALP ÇAVUŞ S,Karakus R,Acar A Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. Klimik Dergisi. 2018; 31(suppl 1): 2 - 18. 10.5152/kd.2018.2
Vancouver ŞENOL E,AZAP A,ERBAY A,ALP ÇAVUŞ S,Karakus R,Acar A Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu. Klimik Dergisi. 2018; 31(suppl 1): 2 - 18. 10.5152/kd.2018.2
IEEE ŞENOL E,AZAP A,ERBAY A,ALP ÇAVUŞ S,Karakus R,Acar A "Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu." Klimik Dergisi, 31, ss.2 - 18, 2018. 10.5152/kd.2018.2
ISNAD ŞENOL, ESİN vd. "Erişkin Bağışıklamasının Hedefindeki Aşılardan Biri Olarak Pnömokok Aşısı: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Erişkin Bağışıklaması Çalışma Grubu Uzlaşı Raporu". Klimik Dergisi 31/suppl 1 (2018), 2-18. https://doi.org/10.5152/kd.2018.2