title: Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain.
abstract: Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.
authors.affiliation: Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Àngela
authors.identifier: http://orcid.org/0000-0003-0219-1907
authors.initials: À
authors.lastname: Domínguez
authors.affiliation: Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Soldevila
authors.affiliation: Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Toledo
authors.affiliation: Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|Agència de Salut Pública de Catalunya, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Torner
authors.affiliation: Hospital de Mataró, Mataró, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Force
authors.affiliation: Hospital Universitario Virgen de Valme, Sevilla, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Pérez
authors.affiliation: Universidad de León, León, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Martín
authors.affiliation: Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Rodríguez-Rojas
authors.affiliation: Consejería de Sanidad, Madrid, Spain.
authors.forename: Jenaro
authors.initials: J
authors.lastname: Astray
authors.affiliation: Hospital de Galdakao, Usansolo, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Egurrola
authors.affiliation: Consorci Hospital General Universitari de Valencia, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanz
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Castilla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D013030:Spain; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines