Clinical efficacy of anti-pneumococcal vaccination in patients with COPD

Pneumology Section, Valme University Hospital, 41014 Seville, Spain.
Thorax (Impact Factor: 8.29). 04/2006; 61(3):189-95. DOI: 10.1136/thx.2005.043323
Source: PubMed


A study was undertaken to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV) in immunocompetent patients with chronic obstructive pulmonary disease (COPD).
A randomised controlled trial was carried out in 596 patients with COPD of mean (SD) age 65.8 (9.7) years, 298 of whom received PPV. The main outcome was radiographically proven community acquired pneumonia (CAP) of pneumococcal or unknown aetiology after a mean period of 979 days (range 20-1454).
There were 58 first episodes of CAP caused by pneumococcus or of unknown aetiology, 25 in the intervention group and 33 in the non-intervention group. Kaplan-Meier survival curves for CAP did not show significant differences between the intervention and non-intervention arms (log rank test = 1.15, p = 0.28) in the whole group of patients. The efficacy of PPV in all patients was 24% (95% CI -24 to 54; p = 0.333). In the subgroup aged <65 years the efficacy of PPV was 76% (95% CI 20 to 93; p = 0.013), while in those with severe functional obstruction (forced expiratory volume in 1 second <40%) it was 48% (95% CI -7 to 80; p = 0.076). In younger patients with severe airflow obstruction the efficacy was 91% (95% CI 35 to 99; p = 0.002). There were only five cases of non-bacteraemic pneumococcal CAP, all in the non-intervention group (log rank test = 5.03; p = 0.025). Multivariate analysis gave a hazard ratio for unknown and pneumococcal CAP in the vaccinated group, adjusted for age, of 0.20 (95% CI 0.06 to 0.68; p = 0.01).
PPV is effective in preventing CAP in patients with COPD aged less than 65 years and in those with severe airflow obstruction. No differences were found among the other groups of patients with COPD.

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Available from: Rafael Vazquez, Oct 06, 2015
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    • "In the other hand, a meta-analysis published by Moberley et al. recommends PPSV23 versus placebo to prevent pneumococcal diseases [52]. RCTs used in that meta-analysis and published between 1980 and 2006 did not found any evidence about PPSV23 as protective vaccine to avoid pneumonia [40,41,53-58]. It means that the conclusion of Moberley et al. is based on only two RCTs: Kaufman (1948) [13] and Riley (1977) [59]. "
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    ABSTRACT: Nowadays, there are to vaccines in Colombia to prevent pneumococcal diseases in people over 50 years. Our aim is to estimate cost-effectiveness of pneumococcal conjugate vaccine 13-valent (PCV13) versus pneumococcal polysaccharide vaccine 23-valent (PPSV23) to prevent diseases and deaths by pneumonia and invasive pneumococcal diseases in people over 50 years old in Colombia. A Markov model was developed with national data, including pneumococcal serotypes distribution in Colombia between 2005 and 2010. Vaccination of a cohort was simulated and a five year time horizon was assumed. Analysis was done from a perspective of a third party payer. Direct costs were provided by a national insurance company; a sensitive univariate probabilistic analysis was done for epidemiological and clinical effectiveness parameters and costs. PCV13 avoids 3 560 deaths by pneumococcal infections versus PPSV23 and 4 255 deaths versus no vaccine. PCV13 prevents 79 633 cases by all-cause pneumonia versus PPSV23 and 81 468 cases versus no vaccine. Total costs (healthcare and vaccines costs) with PCV13 would be U.S. $ 97,587,113 cheaper than PPSV23 and it would save U.S. $ 145,196,578 versus no vaccine. PCV13 would be a cost-saving strategy in the context of a mass vaccination program in Colombia to people over 50 years old because it would reduce burden of disease and specific mortality by pneumococcal diseases, besides, it saves money versus PPSV23.
    BMC Infectious Diseases 03/2014; 14(1):172. DOI:10.1186/1471-2334-14-172 · 2.61 Impact Factor
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    • "In contrast to observational studies22–28 (Table 1), clinical investigations have shown a reduction in risk of death by pneumonia among younger adults and institutionalized elderly subjects vaccinated with PPSV23,29,30 but an effect on mortality from pneumonia has not been consistently documented for high-risk patients or noninstitutionalized older adults.21,31,32 Overall, eight clinical trials evaluated vaccine effectiveness against all-cause pneumonia in elderly people.23,24,32–38 Only two23,35 demonstrated a reduction in risk in the group that received PPSV23. "
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    ABSTRACT: Vaccination remains the primary preventive strategy in the elderly against Streptococcus pneumoniae and influenza infections. The effectiveness of this strategy in preventing pneumonia has been in doubt despite the increase in vaccination coverage among older adults. Randomized controlled trials (RCTs) and observational studies aimed at determining clinical outcomes and immune response following pneumococcal vaccination have yielded conflicting results. The protective efficacy of pneumococcal vaccination against pneumonia in older adults has not been firmly established due to a lack of RCTs specifically examining patients ≥ 65 years of age. Similarly, the reported benefits of influenza vaccination have been derived from observational data. The assessment of clinical benefit from influenza vaccination in the elderly population is complicated by varying cohorts, virulence of the influenza strain, and matching of vaccine and circulating viral strains. The presence of selection bias and use of nonspecific end points in these studies make the current evidence inconclusive in terms of overall benefit. The development of more immunogenic vaccines through new formulations or addition of adjuvants holds the promise of revolutionizing delivery and improving efficacy. Dismantling existing barriers through education, providing technology assistance predominantly to developing countries, and establishing clear regulatory guidance on pathways for approval are necessary to ensure timely production and equitable distribution.
    Clinical Interventions in Aging 11/2012; 7:453-461. DOI:10.2147/CIA.S29675 · 2.08 Impact Factor
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    • "Naturally, the prophylactic strategies against respiratory failure in COPD comprise the avoidance or reduction of disease progression and the prevention or amelioration of exacerbations by vaccination (Alfageme et al 2006; Wongsurakiat et al 2004), anti-inflammatory therapy (Burge et al 2000), long-acting bronchodilators (Mahler et al 1999; Niewoehner et al 2005), or their combination (Calverley et al 2007). In the presence of an exacerbation the treatment of airway obstruction with bronchodilators (Bach et al 2001), and the administration of systemic steroids (Niewoehner et al 1999) and antibiotics are basic in the management of acute respiratory failure. "
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    ABSTRACT: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients withchronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positivepressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failurebecame a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients' adherence to therapy.
    International Journal of COPD 02/2008; 3(4):605-18. · 3.14 Impact Factor
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