Effectiveness of influenza and pneumococcal vaccines on chronic obstructive pulmonary disease exacerbations

Abstract

Background and objective Single‐study evidence of separate and combined effectiveness of influenza and pneumococcal vaccination in patients with chronic obstructive pulmonary disease (COPD) is limited. To fill this gap, we studied the effectiveness of trivalent seasonal influenza vaccine (TIV) and 23‐valent pneumococcal polysaccharide vaccine (PPSV23), separately and together, at preventing adverse COPD outcomes. Methods Our study used a self‐controlled, before‐and‐after cohort design to assess the effectiveness of TIV and PPSV23 in COPD patients. Patients were recruited from hospitals in Tangshan City, Hebei Province, China. Subjects self‐selected into one of the three vaccination schedules: TIV group, PPSV23 group and TIV&PPSV23 group. We used a physician‐completed, medical record‐verified questionnaire to obtain data on acute exacerbations of COPD (AECOPD), pneumonia and related hospitalization. Vaccine effectiveness was determined by comparing COPD outcomes before and after vaccination, controlling for potential confounding using Cox regression. Results We recruited 474 COPD patients, of whom 109 received TIV, 69 received PPSV23 and 296 received TIV and PPSV23. Overall effectiveness for preventing AECOPD, pneumonia and related hospitalization were respectively 70%, 59% and 58% in the TIV group; 54%, 53% and 46% in the PPSV23 group; and 72%, 73% and 69% in the TIV&PPSV23 group. The vaccine effectiveness without COVID‐19 non‐pharmaceutical intervention period were 84%, 77% and 88% in the TIV group; 63%, 74% and 66% in the PPSV23 group; and 82%, 83% and 91% in the TIV&PPSV23 group. Conclusion Influenza vaccination and PPSV23 vaccination, separately and together, can effectively reduce the risk of AECOPD, pneumonia and related hospitalization. Effectiveness for preventing AECOPD was the greatest.

Effect of Influenza Vaccine on Prevention of Acute Attack of Chronic Airway Disease in Elderly Population

“…Chronic airway disease seriously affects the quality of life of patients, and its high incidence rate, high disability rate, and high mortality bring heavy financial burden to patients and their families and society [ 7 ]. This study showed that the ratios of acute attacks, hospitalization times, treatment costs, and hospitalization times of patients with chronic airway disease who received the influenza vaccine were lower than those before vaccination, which is consistent with the results of other studies [ 10 , 16 , 17 ], which indicates that the influenza vaccination can prevent the acute attacks of chronic airway disease. Respiratory diseases are usually avoidable, and the cost of prevention is only a small part of treatment.…”

Vaccination in patients with COPD: COVID has raised the bar

“…The estimates of effect by Li et al 1 for the efficacy of PSV‐23 are not that much larger than suggested by meta‐analyses of randomized controlled trials and a similar recent observational study in Hungary 2 . Walters et al 3 in the last Cochrane analysis of pneumococcal vaccines in COPD found a 41% reduction in pneumonia and a 40% reduction in exacerbations for PSV‐23, but no difference in hospitalizations or death.…”

“…In a recent publication in Respirology , Li et al 1 present data from a 1‐year observational study of the impact of 23‐valent pneumococcal vaccine and influenza vaccine on hospitalizations in patients with COPD in Hebei province in China. In an attempt to adjust for seasonal variation in pathogens, they recorded exacerbations in the 3 years prior to vaccination and compared them in the 1 year following.…”

“… 2 Walters et al 3 in the last Cochrane analysis of pneumococcal vaccines in COPD found a 41% reduction in pneumonia and a 40% reduction in exacerbations for PSV‐23, but no difference in hospitalizations or death. One issue with Li et al 1 is the use of PSV‐23, rather than a newer conjugate vaccine. The 13‐valent conjugate vaccine is clearly more efficacious in preventing pneumonia.…”

“…A recent Canadian study 8 estimated that influenza vaccine was associated with only a 22% reduction in hospitalizations in patients with COPD; however, a number of small randomized trials have had estimates in excess of 50% 9 . It was interesting that the combination of TIV and PSV‐23 was not observed to be as effective by Li et al 1 as has been suggested by other groups 10 . One critical factor may be that the efficacy of influenza vaccine can vary considerably year by year, 11,12 probably due to both the relative match to circulating strains as well as innate immunogenicity of the vaccine.…”