Vaccines for preventing infection with Pseudomonas aeruginosa in people with cystic fibrosis.
OBJECTIVE
To assess the effectiveness of vaccination against Pseudomonas aeruginosa in patients with cystic fibrosis.


METHODS
The Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. Date of the most recent search of the Group's specialised register: November 1999.


METHODS
All randomised or pseudorandomised trials (published or unpublished) comparing Pseudomonas aeruginosa vaccines (oral, parenteral or intranasal) with control vaccines or no intervention in patients with cystic fibrosis.


METHODS
We planned to assess the following outcomes: time to infection with Pseudomonas aeruginosa, pulmonary function, body mass index, Schwachman score, frequency of pulmonary infective exacerbations, days of antibiotic usage, days unable to carry out normal daily activities, adverse events, mortality, antibody levels to Pseudomonas aeruginosa and T cell proliferation and cytokine production in response to Pseudomonas aeruginosa.


RESULTS
One trial which included 17 vaccinated patients, with follow up reported to 10 years met the inclusion criteria. Finding only a single trial, and the lack of information on our predefined outcomes limited analysis.


CONCLUSIONS
There is a paucity of randomised controlled trials assessing the effectiveness of vaccination against Pseudomonas aeruginosa in cystic fibrosis. Increased understanding of modulation of the immune response by vaccination has led to the development of alternative vaccines. We suggest that there is an urgent need for newer vaccines to be evaluated in adequately-powered, multicentre randomised controlled trials examining clinically relevant end-points in addition to immunological variables. Such a trial should assess effectiveness over several years, and include follow-up of vaccinees who become colonised with Pseudomonas aeruginosa.
Keogan
M T
MT
Department of Immunology, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland. mkeogan.rcsi.ie
Johansen
H K
HK
D001428:Bacterial Vaccines; D003550:Cystic Fibrosis / Q000150:complications*; D006801:Humans; D011552:Pseudomonas Infections / Q000150:complications / Q000517:prevention & control*; D054406:Pseudomonas Vaccines; D011550:Pseudomonas aeruginosa / Q000276:immunology*; D017778:Vaccines, Combined
D001428:Bacterial Vaccines; D054406:Pseudomonas Vaccines; D017778:Vaccines, Combined; C039987:polyvalent pseudomonas vaccine