Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: results of the EVAN-65 study.
A prospective cohort study evaluating the clinical effectiveness of the 23-valent pneumococcal polysaccharide vaccine was conducted among 1298 Spanish older adults with chronic respiratory diseases (bronchitis, emphysema or asthma) who were followed between 2002 and 2005. Main outcomes were all-cause community-acquired pneumonia (CAP) and 30 days mortality from CAP. The association between vaccination and the risk of each outcome was evaluated by multivariable Cox proportional-hazard models adjusted for age and comorbidity pneumococcal vaccination did not alter significantly the risk of overall CAP (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.56-1.07) and 30 days mortality from CAP (HR: 0.87; 95% CI: 0.33-2.28). However, a borderline significant reduction of 30% in the risk of all-cause hospitalisation for CAP was observed among vaccinated subjects (HR: 0.70; 95% CI: 0.48-1.00; p=0.052). The effectiveness of the vaccine on the combined endpoint of pneumococcal and unknown organism infections reached 34% (HR: 0.66; 95% CI: 0.43-1.01; p=0.059). Although our findings suggest moderate benefits from the vaccination, the evidence of clinical effectiveness appears limited.
Ochoa-Gondar
Olga
O
Research Unit, Primary Care Service of Tarragona-Valls, Institut Català de la Salut, Tarragona, Spain. olgaochoagondar@wanadoo.es
Vila-Corcoles
Angel
A
Ansa
Xavier
X
Rodriguez-Blanco
T
T
Salsench
Elisabeth
E
de Diego
Cinta
C
Raga
Xavier
X
Gomez
Frederic
F
Valdivieso
Empar
E
Fuentes
Cruzma
C
Palacios
Laura
L
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000401:mortality / Q000517:prevention & control*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012140:Respiratory Tract Diseases; D012307:Risk Factors; D013030:Spain; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome; D014611:Vaccination
D022242:Pneumococcal Vaccines