title: Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: results of the EVAN-65 study.
abstract: 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.
authors.affiliation: Research Unit, Primary Care Service of Tarragona-Valls, Institut Català de la Salut, Tarragona, Spain. olgaochoagondar@wanadoo.es
authors.forename: Olga
authors.initials: O
authors.lastname: Ochoa-Gondar
authors.forename: Angel
authors.initials: A
authors.lastname: Vila-Corcoles
authors.forename: Xavier
authors.initials: X
authors.lastname: Ansa
authors.forename: T
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Salsench
authors.forename: Cinta
authors.initials: C
authors.lastname: de Diego
authors.forename: Xavier
authors.initials: X
authors.lastname: Raga
authors.forename: Frederic
authors.initials: F
authors.lastname: Gomez
authors.forename: Empar
authors.initials: E
authors.lastname: Valdivieso
authors.forename: Cruzma
authors.initials: C
authors.lastname: Fuentes
authors.forename: Laura
authors.initials: L
authors.lastname: Palacios
mesh_terms: 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
chemical_list: D022242:Pneumococcal Vaccines