Protective Effects of the 23‐Valent Pneumococcal Polysaccharide Vaccine in the Elderly Population: The EVAN‐65 Study

Abstract

Background. The 23-valent polysaccharide pneumococcal vaccine (PPV) is currently recommended for elderly persons and persons who are at high risk of infection. However, the effectiveness of the 23-valent PPV remains controversial. We assessed the effectiveness of this vaccine in older adults.Methods. A prospective cohort study was conducted from January 2002 through April 2005; it included all community-dwelling individuals aged у65 years who were assigned to 1 of 8 primary health care centers in Tarragona, Spain (11,241 subjects). The primary outcomes were invasive pneumococcal disease, pneumococcal pneumonia, overall pneumonia rate, and death due to pneumonia. All cases were validated by a check of the clinical records. The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional hazard models, adjusted for age, sex, comorbidity, immunocompetence, and influenza vaccine status.Results. Pneumococcal vaccination was associated with significant reductions in the risk of hospitalization for pneumonia (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.59-0.92) and in the overall pneumonia rate (HR, 0.79; 95% CI, 0.64-0.98). The incidence of invasive pneumococcal disease was low (64 cases per 100,000 person-years), and a considerable protective effect against invasive pneumococcal disease did not attain statistical significance (HR, 0.60; 95% CI, 0.22-1.65). However, the vaccine showed a significant effectiveness of 45% to prevent pneumococcal pneumonia (HR, 0.55; 95% CI, 0.34-0.88). Finally, vaccination was associated with a significant 59% reduction in the risk of death due to pneumonia among vaccinated subjects (HR, 0.41; 95% CI, 0.23-0.72) Conclusions. These results indicate that the 23-valent PPV effectively prevented pneumococcal pneumonia (with or without bacteremia) and decreased the rates of overall pneumonia and of mortality due to pneumonia in older adults, providing new arguments for systematic vaccination in the elderly population.

A pharmacist-driven academic detailing program to increase adult pneumococcal vaccination

“…[23][24][25] Additionally, we observed significant decreases in pneumococcal disease. Though the decline in invasive pneumococcal disease was at the boundary of statistical significance (p=0.05), Rhode Island went from having nearly 20 more cases of invasive disease per year than the overall rate for the United States, to having a similar rate in the post-intervention period.…”

Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany

“…For that reason, we included only studies in which important confounders (at least age and comorbidities) were recorded and taken into account in an adjusted statistical analysis. Three registry-based cohort studies [43,44,46], 3 matched case-control studies [47][48][49], and 4 "case-case studies" using the Broome method [21,[50][51][52] fulfilled this condition. Efficacy against PP was also investigated in a study with a similar case-case design, in which pneumonia cases caused by other pathogens or with no identified pathogen were used as the control group [53].…”

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

“…Indeed, the 37 Maruyama, 2010 (64% against pneumococcal pneumonia and 45% against all cap in nursing home residents); 55 Huss, 2009 (11% in elderly and chronically ill patients against all cap from 11 RcT but high heterogeneity) 54 Vaccine effectiveness …”

“…19 Using the same calculation as used by Jackson et al 5 we obtained a total NBPP incidence of 706/100,000. Vila-Corcoles et al 37 reported an incidence of hospitalized pneumonia in Spain of 1,048/100,000 in elderly (65+) that gave a total NBPP incidence rate of 987/100,000. The study from Ament et al 19 was used in the present analysis because it represents the data of five different countries.…”