Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: Results of the EVAN-65 study

Ochoa-Gondar, Olga; Vila-Córcoles, Ángel; Ansa, Xavier; Rodríguez-Blanco, Teresa; Salsench, Elisabet; Diego, Cinta de; Raga, Xavier; Gómez, Frederic; Valdivieso, Empar; Fuentes, Cruzma; Palacios, Laura

doi:10.1016/j.vaccine.2008.02.021

Cited by 38 publications

(27 citation statements)

References 28 publications

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“…[14][15][16][17][18][19] A major limitation in this study is the lack of spirometric data. If we consider chronic pulmonary disease, the demonstration of airflow obstruction by lung function testing is fundamental in order to establish the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases

Vila-Córcoles

Ochoa-Gondar

Rodríguez-Blanco

et al. 2012

Human Vaccines & Immunotherapeutics

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Background: The effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) is controversial, especially among people with high-risk conditions. This study assessed the clinical effectiveness of vaccination against pneumonia among patients with chronic pulmonary diseases.Methods: We conducted a population-based case-control study including 96 non-immunocompromised patients with clinical diagnosis of chronic pulmonary disease (chronic bronchitis, emphysema and/or asthma), aged 50 y or older, with radiographically confirmed pneumococcal pneumonia (19 bacteremic and 77 nonbacteremic cases) and 192 outpatient control subjects with similar chronic pulmonary diseases (matched by primary care center, age, sex and main comorbidity). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for by underlying conditions.Results: Pneumococcal vaccination did not alter significantly the risk of overall pneumococcal pneumonia [adjusted OR: 0.71; 95% confidence interval (CI): 0.37-1.39]. Point estimates of vaccine effectiveness was the maximum against bacteremic pneumococcal pneumonia due to vaccine-serotypes, although neither reached statistical significance (adjusted OR: 0.51; 95% CI: 0.03-8.19). Vaccination pointed to a smaller benefit against nonbacteremic pneumococcal pneumonia (adjusted OR: 0.66; 95% CI: 0.33-1.34). Pneumococcal vaccination was associated with a non-statistically significant reduction in the risk of all pneumococcal pneumonia among persons 75 y or older (adjusted OR: 0.45; 95% CI: 0.16-1.27), but no apparent protective effect emerged among people 50-74 y (adjusted OR: 1.48; 95% CI: 0.62-3.56).Conclusions: The effectiveness of the PPV-23 in preventing pneumonia among patients with chronic pulmonary disease is uncertain. Our results point to PPV-23 having little or null effect against pneumococcal pneumonia in such patients, but definitive conclusions cannot be established based on our data.

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Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases

Vila-Córcoles

Ochoa-Gondar

Rodríguez-Blanco

et al. 2012

Human Vaccines & Immunotherapeutics

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“…PPSV23 contains the capsular polysaccharide antigens from the 23 most pathogenic pneumococcal serotypes that are responsible for 90% of all invasive infections in adults (4). Reasonable effectiveness for this vaccine has been demonstrated in cohort studies in adults with lung disease (5,6). Despite evidence that antibodies produced in response to PPSV23 can protect against invasive disease in healthy adults, debate remains about its immunogenicity and effectiveness in COPD.…”

mentioning

confidence: 99%

Superior Immune Response to Protein-Conjugate versus Free Pneumococcal Polysaccharide Vaccine in Chronic Obstructive Pulmonary Disease

Dransfield

Nahm

Han

et al. 2009

Am J Respir Crit Care Med

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Rationale: Debate exists about the immunogenicity and protective efficacy of antibodies produced by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in chronic obstructive pulmonary disease (COPD). The 7-valent diphtheria-conjugated pneumococcal polysaccharide vaccine (PCV7) induces a more robust immune response than PPSV23 in healthy elderly adults. Objectives: We hypothesized that serotype-specific IgG antibody concentration and functional antibody activity would be superior after PCV7 vaccination compared with PPSV23 in moderate to severe COPD. We also posited that older age and prior PPSV23 vaccination would be associated with reduced vaccine responsiveness. Methods: One hundred twenty patients with COPD were randomized to PPSV23 (63 subjects) or PCV7 (57 subjects). IgG concentrations were determined by ELISA; functional antibody activity was assayed with a standardized opsonophagocytosis assay and reported as an opsonization killing index (OPK). Increases in serotype-specific IgG and OPK at 1 month post vaccination were compared within and between vaccine groups. Measurements and Main Results: Both vaccines were well tolerated. Within each study group, postvaccination IgG and OPK were higher than baseline (P , 0.01) for all serotypes. Adjusted for baseline levels, postvaccination IgG was higher in the PCV7 group than the PPSV23 group for all seven serotypes, reaching statistical significance for five (P , 0.05). PCV7 resulted in a higher OPK for six of seven serotypes (statistically greater for four) compared with PPSV23. In multivariate analyses, younger age, vaccine naivety, and receipt of PCV7 were associated with increased OPK responses. Conclusions: PCV7 induces a superior immune response at 1 month post vaccination compared with PPSV23 in COPD. Older age and prior PPSV23 reduce vaccine responsiveness. Clinical trial registered with www.clinicaltrials.gov (NCT00457977).

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“…Thus, although nonRCTs have inherent limitations (especially the possibility of selection bias), they can provide interesting data on the effectiveness and impact of the vaccination. In this way, several observational studies have reported benefits using the PPV-23 in patients with chronic respiratory diseases (Nichol 1999, Ochoa-Gondar 2008, Watanuki 2008, Sumitani 2008). …”

Section: Pneumococcal Polysaccharide Vaccinementioning

confidence: 97%

“…In the United States, the reported annual incidence of hospitalisation for CAP was 11 cases per 1000 among the general population over 65 yearsold and 41 cases per 1000 among those patients with chronic lung diseases (Jackson 2003). In Europe, incidences of 14 and 46 episodes per 1000 person-year have been reported among the general population and COPD patients, respectively (Vila-Corcoles 2006, Ochoa-Gondar 2008. Pneumococcus remains the most common microorganism identified among patients with chronic respiratory diseases with CAP (Liebermen 2002, Mandell 2007) although Gram-negative bacilli are increasing in patients with severe obstruction (Restrepo 2008, Ko 2008.…”

Section: Introductionmentioning

confidence: 99%

“…Pneumococcus remains the most common microorganism identified among patients with chronic respiratory diseases with CAP (Liebermen 2002, Mandell 2007) although Gram-negative bacilli are increasing in patients with severe obstruction (Restrepo 2008, Ko 2008. Incidences of laboratory-confirmed pneumococcal CAP ranged from 0.5 to 2.1 per 1000 in the general population and 0.7 to 5.9 per 1000 among patients with chronic pulmonary disease (Jackson 2003, Vila-Corcoles 2006, Alfegeme 2006, Ochoa-Gondar 2008 of which approximately 25% were bacteremic and 75% non-bacteremic cases. These figures are likely to be an underestimation of the true incidence of pneumococcal bacteremia because they do not take into account persons from whom blood cultures were never obtained or those where the culture was performed after the start of antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antipneumococcal Vaccination in COPD Patients

Vila-Córcoles¹,

Ochoa-Gondar²

2012

Chronic Obstructive Pulmonary Disease - Current Concepts and Practice

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Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: Results of the EVAN-65 study

Cited by 38 publications

References 28 publications

Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases

Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases

Superior Immune Response to Protein-Conjugate versus Free Pneumococcal Polysaccharide Vaccine in Chronic Obstructive Pulmonary Disease

Antipneumococcal Vaccination in COPD Patients

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