Research Paper on Comparing Effectiveness of Vaccines Against Pneumococcal Infections in Elderly

Introduction

Various vaccines have been used to prevent the occurrence of pneumococcal infections among the elderly and their efficiency in reducing the mortality rate caused by the condition. To achieve this, a comparison was conducted between the effectiveness of pneumococcal polysaccharide 23 vaccine (PPV23) and that of pneumococcal conjugate vaccine 13 (PCV13) at preventing incidences on pneumococcal- related infections alongside the mortality rates. Two research articles were used to provide an in-depth understanding through case scenarios and the findings from the same.

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The first article is the "Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among the elderly in the Netherlands."he second one is the Efficacy of 23 valent pneumococcal vaccines and improving survival in nursing home residents. This paper will analyze the relationship between these two articles to the PICOT question. Further, the ethical considerations and discussion of its relevance to the practice of nursing and will be provided.

Nursing Practice Problem and PICOT Statement

The morbidity and mortality rates in nursing homes are high due to the causative agent Streptococcus pneumoniae, which is a pathogen. The residents of these nursing homes are significantly affected while the vaccine administration is low in the region of 5%. Among the reasons that can be attributed to the condition is the absence of strong evidence to illustrate the effectiveness of the PPV23 on those residing in nursing homes. This incidence occurs even though the vaccine is typically suggested to those with a higher risk of pneumococcal infection. The other reason is that the evidence on its efficacy has been based on information from community-acquired pneumonia.

The PICOT question seeks to ascertain the effectiveness of the PPV23 vaccine in treating the infections and reducing mortality rates primarily among the elderly who are at high risk. There have been reports about increasing cases of pneumococcal infections among nursing residents. It is due to such matters that nursing home residents need were used in the research as no previous research had been conducted on these people. Analyzing the two articles will be essential in determining the effectiveness and impact of PPV23 compared to that of PCV13 in treating the disease among the elderly who possess high-risk factors.

Background of the Study

The first article on the Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among the elderly in the Netherlands identified that the pathogen caused infections leading to morbidity and mortality among individuals of all ages in the Netherlands (Thorrington, et al., 2018). The country receives the 10-valent pneumococcal conjugate vaccine abbreviated as PCV10, but the older individuals are not targeted.

The authors assessed the cost-effectiveness and impact of PPV23 or PCV13 among the elderly aged 60, 65, or 70. The authors also found out that the pathogen causes diseases of several severity degrees without or with admission to the hospital via invasive pneumococcal disease such as sepsis. The research was also conducted since some people are at a higher risk of severe infections such as the elderly and the infants. Findings from this research article will help in the provision of information regarding the cost-effectiveness and impact of various vaccination strategies among the elderly.

The second article on the Efficacy of 23 valent pneumococcal vaccines and improving survival in nursing home residents was based on the identification of Streptococcus pneumoniae as the primary causative agent of high rates of pneumonia-related morbidity and mortality cases among nursing homes residents (Maruyama, et al., 2010). Besides, it was found out that there is a low prevalence of the vaccination compared to the reports about an outbreak of the disease among residents in nursing homes.

Moreover, the occurrence of the disease in nursing homes has been attributed to the lack of research and enough data on the vaccine's effectiveness in preventing or treating the condition. The study was conducted in an attempt to bridge the knowledge gap and in the provision of data towards the efficiency of PPV23 among the elderly. The research information will be useful in understanding why and whether PPV23 is a better vaccine for the affected group.

Methods of Study

The first article incorporated various techniques, with the primary model being a static cost-effectiveness model. The model played a critical role in quantifying the impacts of different strategies of vaccination from the healthcare provider's perspective. There were several parameters vital to the model, including expert opinions, literature values, and surveillance data. These parameters were essential in cases where inconsistency of information appeared. The various strategies employed a ten-year time horizon for the vaccine's price lists. The participants were the elderly groups of adults in the age of 60, 65, and 70years.

The second article involved nine hospitals and twenty-three hospital-associated nursing homes where participants were randomly given either the pneumococcal polysaccharide 23 vaccine or placebo in equal amounts. These vaccines were administered intramuscularly and through a multicenter study. The placebo and the vaccines were labeled sequentially with similar needle and syringes only for administration. A member who was not part of the study team carried out the randomization with the help of a randomization number table who also numbered the containers. Participants were evaluated for eligibility of the study, and necessary follow-ups were done at the end of the study.

Results of the Study

The two articles were both evidence-based and, as such, were crucial in determining their relevance to the issues under study. The study that was conducted among the elderly in the Netherlands showed essential findings, especially in terms of costs associated with treatment. Results revealed that the treatment of the elderly cohort with the PCV13 vaccine had the highest budget impact, with values ranging in the region of EUR 7.92 million using the assumption of an average list price of EUR 72.67. However, with the use of the PPV23 vaccine on the same group of people, the costs were cheaper in the region of EUR 2.31 million assuming an average list price of EUR 21.20 Thorrington, et al., 2018). These findings reveal the different costs of using various vaccination strategies among several ages of people. In general, it was concluded that vaccinating the elderly with a single or multi-dose of the PPV23 vaccine.

The second research study also revealed critical findings concerning the efficacy of the PPV23 vaccine and its role in improving the survival chances of residents of nursing homes. From the results, it was worth concluding that the PPV23 vaccine had significant impacts. Cases of all-cause pneumonia and pneumococcal pneumonia were lower in vaccine individuals as compared to the placebo group. 2.8% of the vaccine group were diagnosed with pneumococcal pneumonia against 7.3% of the placebo group (Maruyama, et al., 2010). Also, the survival curves depicted a higher cumulative figure of people vaccinated with PPV23 without pneumococcal pneumonia (Maruyama, et al., 2010). In general, the 23-valent pneumococcal polysaccharide vaccine substantially prevented death cases resulting from pneumococcal pneumonia among nursing home residents.

Ethical Considerations

All the research studies adhered to the ethical considerations and protocols as required while conducting research. Ethical considerations for the first study mainly pertained to the interpretation of the results. The projections used to determine the findings were illustrative and straightforward. Furthermore, some limiting factors played a little part in attaining the validity of the estimated predictions. One is the possibility of an indirect effect by the PCV13 from the modeled one. The other is about the used list price in that the national government may not use it upon use at a national level.

The second article also observed ethical considerations. The study ensured that all participants satisfied the criteria of the safety essential for vaccine injection. The test was conducted in nursing homes as those residing there are taken care of by the medical staff, thereby ensuring minimal adverse effects that may arise from the use of the vaccine. Furthermore, no severe side effects developed after the vaccination. Finally, the research was approved after justification by the review board of Mie University.

Link Between Research, Research Problem and PICOT

The relationship between research, the problem of ascertaining the effectiveness of PPV23 in reducing the mortality rates among the elderly at a higher risk, and the PICOT were discovered. The research findings from the two articles indicated significant elements in bridging the existing gap. The cost-effectiveness of the drugs has been established, which was a critical element of the study. Also, its impact has been found to have more significant benefits to adults with more than 70 years of age. The PPV23 vaccine has also been found to be cheaper, and its efficacy significant, especially in reducing the mortality and morbidity rates among adults.

The elderly as the population captured in the PICOT question will significantly benefit from reduced mortality rates from pneumococcal diseases and also from a cost-effective drug. The drug will improve the health conditions in nursing homes and help to develop better means of taking care of the elderly. Findings from these articles will also serve as sources of reliable information in further research.

Proposed Change of Practice

Taking care of the elderly, especially those with high-risk factors, can be done in a better and improved manner. In the practice of nursing, several proposals can be suggested using the research work as evidence-based references to cement the justification of the proposed ideas. The recommended vaccination strategies and cost-effective techniques can be used to develop a cheaper means of acquiring medication, especially for the elderly. Improving the morbidity and mortality rates will go a long way in improving healthcare delivery.

Conducting proper techniques of delivering healthcare is a vast improvement for society. The use of the PPV23 vaccine can be further researched to develop better means of administering such medications. Furthermore, due to its cost-effectiveness, it would be easily affordable, and as such, it would be a step further towards attaining universal healthcare.

Conclusion

In conclusion, the practice of delivering quality healthcare is a fundamental obligation for healthcare providers and other medical personnel. However, a lot can still be done to improve the services being offered. The articles have proven useful in deriving information that would help in enhancing the elderly both financially and health-wise. On that note, I would recommend the implementation of the necessary procedures that aid in the administration of better healthcare. This move will prove significant in the attainment of universal healthcare.

References

Maruyama, T., Taguchi, O., Niederman, M. S., Morser, J., Kobayashi, H., Kobayashi, T., . . . Gabazza, E. C. (2010). Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double-blind, randomized and placebo-controlled trial. British Medical Journal, 340(c1004), 1-7. doi:10.1136/bmj.c1004