CAP remains a major cause of morbidity and mortality in older adults. Incidence rates in this study largely doubled prior rates reported in Southern European regions.

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.

Our data support a protective effect of recent PPV23 vaccination (within previous 5 years) against both pneumococcal and all-cause CAP.

Background: Community-acquired pneumonia (CAP) is generally considered a major cause of morbidity and mortality in the elderly. However, population-based data are very limited and its overall burden is unclear. This study assessed incidence and mortality from CAP among Spanish community-dwelling elderly.

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Our results suggest a benefit from the influenza vaccination and support an annual vaccination strategy for elderly people with cardiac diseases.

The present study assessed the effectiveness of the 23-valent pneumococcal polysaccharide vaccine to prevent pneumonia and death in older adults in a first-time report between January and December 2002.A prospective cohort study was conducted including all individuals o65 yrs of age assigned to one of eight primary care centres in Tarragona, Spain (n511,241). The primary outcomes were community-acquired pneumonia (hospitalised or outpatient) and death from pneumonia. All pneumonias were validated by checking clinical records. The association between the pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional-hazard models, adjusted by age, sex, influenza vaccination status, comorbidity and immunological status.Pneumococcal vaccination did not alter the risk of hospitalisation from pneumonia (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.50-1.28) or overall pneumonia (HR: 0.86; 95% CI: 0.56-1.31), but the vaccine was associated with considerable reductions of death risk from pneumonia (HR: 0.28; 95% CI: 0.09-0.83).In conclusion, these results suggest that pneumococcal polysaccharide vaccine may not be effective in reducing the incidence of pneumonia, but may be able to diminish the severity of the infection. These findings support the effectiveness of the pneumococcal polysaccharide vaccine to prevent mortality caused by pneumonia in older adults, providing a new argument to recommend systematic vaccination in the elderly.

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