A randomized study comparing combined pneumococcal conjugate and polysaccharide vaccination schedules in adults

Rajeka Lazarus, Elizabeth Clutterbuck, Ly-Mee Yu, Jaclyn Bowman, Elizabeth A Bateman, Linda Diggle, Brian Angus, Tim E Peto, Peter C Beverley, David Mant, Andrew J Pollard

Research output: Contribution to journalArticle (Academic Journal)peer-review

92 Citations (Scopus)


BACKGROUND: The widely used 23-valent plain polysaccharide vaccine (23vP) has limited effectiveness, produces short-lived immune responses, and induces attenuated antibody production after subsequent challenge with pneumococcal vaccines. Our goal was to examine whether priming with the 7-valent pneumococcal conjugate vaccine (PCV7) could enhance the immunogenicity of 23vP for the PCV7 serotypes and to investigate whether 23vP induced hyporesponsiveness could be overcome using PCV7.

METHODS: We conducted an open-label randomized study that compared 3 vaccine schedules, each of which consisted of 2 doses of PCV7 and 1 dose of 23vP (23vP-PCV7-PCV7, PCV7-23vP-PCV7, PCV7-PCV7-23vP) administered over a 1-year period in a cohort of 348 adults 50-70 years of age. All vaccines were administered intramuscularly and were given 6 months apart. Blood samples were obtained prior to and 1 month after each vaccination.

RESULTS: 23vP administered after priming with 2 doses of PCV7 produced significantly higher antibody concentrations for 3 of the 7 PCV7 serotypes, compared with vaccination with a single dose of 23vP; however, the same immunogenicity could be achieved with a single dose of PCV7. Prior vaccination with 23vP attenuated the antibody response to subsequent PCV7, which was not restored by additional doses of PCV7.

CONCLUSION: In adults, vaccination schedules combining PCV7 and 23vP do not provide improved immunogenicity over the use of a single dose of 23vP for most of the serotypes contained in PCV7.

Original languageEnglish
Pages (from-to)736-42
Number of pages7
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Issue number6
Publication statusPublished - 15 Mar 2011


  • Aged
  • Antibodies, Bacterial/blood
  • Female
  • Heptavalent Pneumococcal Conjugate Vaccine
  • Humans
  • Immunization Schedule
  • Immunization, Secondary/methods
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Pneumococcal Vaccines/administration & dosage
  • Vaccination/methods


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