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Should UK pneumococcal vaccine eligibility criteria include alcohol dependency?

Researchers at the University of Sunderland say North East England should be used as a “testing ground” for extending the criteria for pneumococcal vaccination to include those with alcoholism as a target group.

At present, the UK Department of Health’s Green Book advises that the 23-valent pneumococcal polysaccharide (PPSV23) vaccine is relatively ineffective in ‘alcoholism’, although it is recommended for individuals with chronic liver disease as an appropriate clinical risk group. By not specifically recommending PPSV23 vaccine for those with alcoholism, the current UK guidance is at variance with guidelines in other countries including Finland, Ireland and the US.

A recently reported steep increase in the incidence of invasive pneumococcal disease (IPD) in adults in the North East of England has been primarily associated with pneumococcal sero-types found in the PPSV23 vaccine. This region also has one of the highest rates of alcohol-related premature mortality and morbidity in the UK.

In an article, published in the journal Vaccine, the authors say the region “might represent a worthwhile testing ground for a reappraisal of the vaccine guidance, namely to include those with alcoholism within the target group recommended to receive PPSV23 vaccine”.

While acknowledging that there are probably insufficient grounds at present for a UK-wide revision of vaccine guidance, the authors say “some form of experimental trial with matching English region(s) of equivalent alcohol impact as controls (such as the North West), would constitute an informative and highly policy-relevant intervention using a quasi-experimental design”.


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