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Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases: a matched case-control study.

Abstract

BACKGROUND

The effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) is controversial, especially among people with high-risk conditions. This study assessed the clinical effectiveness of vaccination against pneumonia among patients with chronic pulmonary diseases.

METHODS

We conducted a population-based case-control study including 96 non-immunocompromised patients with clinical diagnosis of chronic pulmonary disease (chronic bronchitis, emphysema and/or asthma), aged 50 y or older, with radiographically confirmed pneumococcal pneumonia (19 bacteremic and 77 nonbacteremic cases) and 192 outpatient control subjects with similar chronic pulmonary diseases (matched by primary care center, age, sex and main comorbidity). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for by underlying conditions.

RESULTS

Pneumococcal vaccination did not alter significantly the risk of overall pneumococcal pneumonia [adjusted OR: 0.71; 95% confidence interval (CI): 0.37-1.39]. Point estimates of vaccine effectiveness was the maximum against bacteremic pneumococcal pneumonia due to vaccine-serotypes, although neither reached statistical significance (adjusted OR: 0.51; 95% CI: 0.03-8.19). Vaccination pointed to a smaller benefit against nonbacteremic pneumococcal pneumonia (adjusted OR: 0.66; 95% CI: 0.33-1.34). Pneumococcal vaccination was associated with a non-statistically significant reduction in the risk of all pneumococcal pneumonia among persons 75 y or older (adjusted OR: 0.45; 95% CI: 0.16-1.27), but no apparent protective effect emerged among people 50-74 y (adjusted OR: 1.48; 95% CI: 0.62-3.56).

CONCLUSIONS

The effectiveness of the PPV-23 in preventing pneumonia among patients with chronic pulmonary disease is uncertain. Our results point to PPV-23 having little or null effect against pneumococcal pneumonia in such patients, but definitive conclusions cannot be established based on our data.

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  • Authors+Show Affiliations

    ,

    Primary Care Service of Tarragona-Valls, Institut Catalá de la Salut, Tarragona, Spain.

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    Source

    MeSH

    Aged
    Aged, 80 and over
    Case-Control Studies
    Chronic Disease
    Female
    Humans
    Immunologic Factors
    Male
    Middle Aged
    Pneumococcal Vaccines
    Pneumonia, Pneumococcal
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22634442

    Citation

    Vila-Corcoles, Angel, et al. "Clinical Effectiveness of 23-valent Pneumococcal Polysaccharide Vaccine Against Pneumonia in Patients With Chronic Pulmonary Diseases: a Matched Case-control Study." Human Vaccines & Immunotherapeutics, vol. 8, no. 5, 2012, pp. 639-44.
    Vila-Corcoles A, Ochoa-Gondar O, Rodriguez-Blanco T, et al. Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases: a matched case-control study. Hum Vaccin Immunother. 2012;8(5):639-44.
    Vila-Corcoles, A., Ochoa-Gondar, O., Rodriguez-Blanco, T., Gutierrez-Perez, A., & Vila-Rovira, A. (2012). Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases: a matched case-control study. Human Vaccines & Immunotherapeutics, 8(5), pp. 639-44. doi:10.4161/hv.19466.
    Vila-Corcoles A, et al. Clinical Effectiveness of 23-valent Pneumococcal Polysaccharide Vaccine Against Pneumonia in Patients With Chronic Pulmonary Diseases: a Matched Case-control Study. Hum Vaccin Immunother. 2012;8(5):639-44. PubMed PMID: 22634442.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases: a matched case-control study. AU - Vila-Corcoles,Angel, AU - Ochoa-Gondar,Olga, AU - Rodriguez-Blanco,Teresa, AU - Gutierrez-Perez,Antonia, AU - Vila-Rovira,Angel, AU - ,, Y1 - 2012/05/01/ PY - 2012/5/29/entrez PY - 2012/5/29/pubmed PY - 2013/1/10/medline SP - 639 EP - 44 JF - Human vaccines & immunotherapeutics JO - Hum Vaccin Immunother VL - 8 IS - 5 N2 - BACKGROUND: The effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) is controversial, especially among people with high-risk conditions. This study assessed the clinical effectiveness of vaccination against pneumonia among patients with chronic pulmonary diseases. METHODS: We conducted a population-based case-control study including 96 non-immunocompromised patients with clinical diagnosis of chronic pulmonary disease (chronic bronchitis, emphysema and/or asthma), aged 50 y or older, with radiographically confirmed pneumococcal pneumonia (19 bacteremic and 77 nonbacteremic cases) and 192 outpatient control subjects with similar chronic pulmonary diseases (matched by primary care center, age, sex and main comorbidity). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for by underlying conditions. RESULTS: Pneumococcal vaccination did not alter significantly the risk of overall pneumococcal pneumonia [adjusted OR: 0.71; 95% confidence interval (CI): 0.37-1.39]. Point estimates of vaccine effectiveness was the maximum against bacteremic pneumococcal pneumonia due to vaccine-serotypes, although neither reached statistical significance (adjusted OR: 0.51; 95% CI: 0.03-8.19). Vaccination pointed to a smaller benefit against nonbacteremic pneumococcal pneumonia (adjusted OR: 0.66; 95% CI: 0.33-1.34). Pneumococcal vaccination was associated with a non-statistically significant reduction in the risk of all pneumococcal pneumonia among persons 75 y or older (adjusted OR: 0.45; 95% CI: 0.16-1.27), but no apparent protective effect emerged among people 50-74 y (adjusted OR: 1.48; 95% CI: 0.62-3.56). CONCLUSIONS: The effectiveness of the PPV-23 in preventing pneumonia among patients with chronic pulmonary disease is uncertain. Our results point to PPV-23 having little or null effect against pneumococcal pneumonia in such patients, but definitive conclusions cannot be established based on our data. SN - 2164-554X UR - https://www.unboundmedicine.com/medline/citation/22634442/Clinical_effectiveness_of_23_valent_pneumococcal_polysaccharide_vaccine_against_pneumonia_in_patients_with_chronic_pulmonary_diseases:_a_matched_case_control_study_ L2 - http://www.tandfonline.com/doi/full/10.4161/hv.19466 DB - PRIME DP - Unbound Medicine ER -