Table 5.
Additional aspects that need consideration in the elderly
| • Burden of pneumococcal disease varies in different regions |
| - Different rates of risk factors such as smoking, HIV, other comorbidities in the population or community |
| • Herd protection may be different geographically as may the residual burden of disease |
| - Different susceptibilities of the hosts, which childhood vaccines are used, and their coverage rate, force of transmission, proportion of disease caused by vaccine serotype |
| • Does herd protection have a limit? |
| • Decline of PCV13 serotypes in adults is attenuated by older age and comorbidity |
| • Underestimation of residual pneumococcal disease |
| - Especially of non-invasive infection, and/or when using conventional microbiological methods only |
| • Serotype replacement disease |
| - Varies in different countries |