Article

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

ABSTRACT

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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    • "Pneumococcal vaccination is recommended in patients with chronic pulmonary conditions and has been shown to reduce the rates of invasive pneumococcal disease (IPD) [7]. Studies of effectiveness of PPV-23 in this group of patients have yielded inconclusive results [8] [9] [10]. Moreover, immunity may wane more rapidly in COPD patients [11] [12]. "
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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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    Full-text · Article · Mar 2014 · BMC Infectious Diseases
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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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    Full-text · Article · Nov 2012 · Clinical Interventions in Aging
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