title: Prophylactic vaccinations in chronic obstructive pulmonary disease: current status.
abstract: OBJECTIVE
  Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity and mortality worldwide. Most acute exacerbations are triggered by community-acquired respiratory infections. Medications to treat COPD exacerbations are limited; therefore, identifying effective ways to prevent exacerbations are needed. Influenza and pneumococcal vaccines are currently recommended for all persons with COPD. However, current immunization rates are far lower than the Healthy People 2010 Goals. The reasons for nonadherence are multifactorial and strategies for overcoming these barriers are discussed.
  
  
  RESULTS
  Influenza vaccine clearly reduces the number of acute exacerbations that occur in persons with COPD. Influenza vaccine may reduce hospitalizations and mortality from COPD, but the evidence is not conclusive. Pneumococcal vaccine reduces the incidence of invasive pneumococcal disease. However, there is not enough evidence to conclude that pneumococcal vaccination in persons with COPD has a significant impact on reducing morbidity or mortality. Vaccination with both influenza and pneumococcal vaccine may produce an additive effect that reduces exacerbations more effectively than either vaccine alone. Whole genome sequencing of bacteria and genome mining may represent a powerful way to identify novel potential vaccine antigens for future vaccine development.
  
  
  CONCLUSIONS
  Although clinical trial data are limited, vaccinations can prevent some of the infections that cause COPD exacerbations and should be administered to all patients with COPD. Vaccines do not cause exacerbations of COPD. Patient and physician barriers to vaccination can be overcome with targeted education and system-wide interventions. Further research efforts should focus on improving current vaccines and identifying novel targets for future vaccine development.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. jay.varkey@duke.edu
authors.forename: Jay B
authors.initials: JB
authors.lastname: Varkey
authors.forename: Anita B
authors.initials: AB
authors.lastname: Varkey
authors.forename: Basil
authors.initials: B
authors.lastname: Varkey
mesh_terms: D017714:Community-Acquired Infections / Q000150:complications; D019983:Guideline Adherence; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000382:microbiology / Q000517:prevention & control* / Q000821:virology
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines