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Effectiveness of pneumococcal polysaccharide vaccine in older adults.
N Engl J Med. 2003 May 01; 348(18):1747-55.NEJM

Abstract

BACKGROUND

Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of community-acquired pneumonia. In a large population of older adults, we assessed the effectiveness of the pneumococcal vaccine.

METHODS

In this retrospective cohort study, 47,365 Group Health Cooperative members 65 years of age or older were assessed over a three-year period. The primary outcomes were hospitalization because of community-acquired pneumonia (validated by chart review), pneumonia in patients who were not hospitalized ("outpatient pneumonia," determined from administrative data sources), and pneumococcal bacteremia. The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional-hazards models, with adjustment for age, sex, nursing-home residence or nonresidence, smoking status, medical conditions, and receipt or nonreceipt of influenza vaccine.

RESULTS

During the study period, 1428 cohort members were hospitalized with community-acquired pneumonia, 3061 were assigned a diagnosis of outpatient pneumonia, and 61 had pneumococcal bacteremia. Receipt of the pneumococcal vaccine was associated with a significant reduction in the risk of pneumococcal bacteremia (hazard ratio, 0.56; 95 percent confidence interval, 0.33 to 0.93) but a slightly increased risk of hospitalization for pneumonia (hazard ratio, 1.14; 95 percent confidence interval, 1.02 to 1.28). Pneumococcal vaccination did not alter the risk of outpatient pneumonia (hazard ratio, 1.04; 95 percent confidence interval, 0.96 to 1.13) or of any case of community-acquired pneumonia, whether or not it required hospitalization (hazard ratio, 1.07; 95 percent confidence interval, 0.99 to 1.14).

CONCLUSIONS

These findings support the effectiveness of the pneumococcal polysaccharide vaccine for the prevention of bacteremia, but they suggest that alternative strategies are needed to prevent nonbacteremic pneumonia, which is a more common manifestation of pneumococcal infection in elderly persons.

Authors+Show Affiliations

Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. jackson.l@ghc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12724480

Citation

Jackson, Lisa A., et al. "Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults." The New England Journal of Medicine, vol. 348, no. 18, 2003, pp. 1747-55.
Jackson LA, Neuzil KM, Yu O, et al. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med. 2003;348(18):1747-55.
Jackson, L. A., Neuzil, K. M., Yu, O., Benson, P., Barlow, W. E., Adams, A. L., Hanson, C. A., Mahoney, L. D., Shay, D. K., & Thompson, W. W. (2003). Effectiveness of pneumococcal polysaccharide vaccine in older adults. The New England Journal of Medicine, 348(18), 1747-55.
Jackson LA, et al. Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults. N Engl J Med. 2003 May 1;348(18):1747-55. PubMed PMID: 12724480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of pneumococcal polysaccharide vaccine in older adults. AU - Jackson,Lisa A, AU - Neuzil,Kathleen M, AU - Yu,Onchee, AU - Benson,Patti, AU - Barlow,William E, AU - Adams,Annette L, AU - Hanson,Christi A, AU - Mahoney,Lisa D, AU - Shay,David K, AU - Thompson,William W, AU - ,, PY - 2003/5/2/pubmed PY - 2003/5/8/medline PY - 2003/5/2/entrez SP - 1747 EP - 55 JF - The New England journal of medicine JO - N Engl J Med VL - 348 IS - 18 N2 - BACKGROUND: Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of community-acquired pneumonia. In a large population of older adults, we assessed the effectiveness of the pneumococcal vaccine. METHODS: In this retrospective cohort study, 47,365 Group Health Cooperative members 65 years of age or older were assessed over a three-year period. The primary outcomes were hospitalization because of community-acquired pneumonia (validated by chart review), pneumonia in patients who were not hospitalized ("outpatient pneumonia," determined from administrative data sources), and pneumococcal bacteremia. The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional-hazards models, with adjustment for age, sex, nursing-home residence or nonresidence, smoking status, medical conditions, and receipt or nonreceipt of influenza vaccine. RESULTS: During the study period, 1428 cohort members were hospitalized with community-acquired pneumonia, 3061 were assigned a diagnosis of outpatient pneumonia, and 61 had pneumococcal bacteremia. Receipt of the pneumococcal vaccine was associated with a significant reduction in the risk of pneumococcal bacteremia (hazard ratio, 0.56; 95 percent confidence interval, 0.33 to 0.93) but a slightly increased risk of hospitalization for pneumonia (hazard ratio, 1.14; 95 percent confidence interval, 1.02 to 1.28). Pneumococcal vaccination did not alter the risk of outpatient pneumonia (hazard ratio, 1.04; 95 percent confidence interval, 0.96 to 1.13) or of any case of community-acquired pneumonia, whether or not it required hospitalization (hazard ratio, 1.07; 95 percent confidence interval, 0.99 to 1.14). CONCLUSIONS: These findings support the effectiveness of the pneumococcal polysaccharide vaccine for the prevention of bacteremia, but they suggest that alternative strategies are needed to prevent nonbacteremic pneumonia, which is a more common manifestation of pneumococcal infection in elderly persons. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12724480/Effectiveness_of_pneumococcal_polysaccharide_vaccine_in_older_adults_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa022678?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -