Impact of prior pneumococcal vaccination on clinical outcomes in HIV‐infected adult patients hospitalized with invasive pneumococcal disease

Abstract

Background Recent studies in hospitalized patients with community‐acquired pneumonia have found a lower risk of bacteraemia and better clinical outcomes in patients who had previously received the 23‐valent pneumococcal polysaccharide vaccine (PPV) in comparison with unvaccinated individuals. The aim of this study was to assess the influence of prior PPV on clinical outcomes in HIV‐infected adult patients hospitalized with invasive pneumococcal disease (IPD). Methods This was an observational study of all consecutive HIV‐infected adults hospitalized with IPD from January 1996 to October 2007 in three hospitals in Spain. Baseline characteristics and clinical outcome‐related variables were compared according to prior PPV vaccination status. Results A total of 162 episodes of IPD were studied. In 23 of these (14.2%), patients had previously received PPV. In both vaccinated and unvaccinated patients, most of the causal serotypes were included in the 23‐valent PPV (76.9% and 84.1%, respectively). Overall, 25 patients (15.4%) died during hospitalization, 21 patients (13%) required admission to an intensive care unit (ICU) and 34 patients (21%) reached the composite outcome of death and/or admission to the ICU. None of the 23 patients who had previously received PPV died or required ICU admission, in comparison with 25 (18%; P=0.026) and 21 (15.1%; P=0.046), respectively, of the unvaccinated patients. The length of hospital stay for vaccinated patients was significantly shorter (8.48 vs. 13.27 days; P=0.011). Conclusions Although 23‐valent PPV failed to prevent IPD in some HIV‐infected patients, vaccination produced beneficial effects on clinical outcomes by decreasing illness severity and mortality related to IPD.

Clinical Features, Etiology, and Outcomes of Community-Acquired Pneumonia in Patients With Diabetes Mellitus

“…In this regard, some studies have found that pneumococcal polysaccharide vaccine is effective in preventing hospitalizations for pneumonia 8 and reduces the rates of ICU admission and inhospital mortality in immunosuppressed and nonimmunosuppressed patients with CAP or invasive pneumococcal disease. 15,21–33 However, there is little evidence of vaccine protection for pneumonia. 30 …”

Humoral immune responses to Streptococcus pneumoniae in the setting of HIV-1 infection

“…IgM+ memory B cells are depleted and pneumococcal-specific Ab responses to pneumococcal vaccination are impaired in HIV-infected patients, even in patients who have received long-term ART [25, 126]. Due to the high risk for HIV patients to develop IPD [25, 66, 68, 100, 127], research is critically important to better understand Ab concentrations against pneumococcal polysaccharide serotypes in PPV- and PCV-immunized HIV-infected individuals. Research studies have shown that PCV immunization initiated an enhanced serotypic-specific IgG response to PPV, which led to an increased Abs against PPS 14, 19F and 23F serotypes, both in HIV-infected individuals and healthy individuals, compared with those immunized with PPV alone, suggesting that immunization with both PPV and PCV induced a better protective effect [128-131].…”

Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes

“…Some studies have observed better clinical outcomes in patients who had previously received the PPV-23 compared with unvaccinated individuals [26,27]. We also observed this beneficial effect on the incidence of septic shock and survival in vaccinated patients with HIV infection who developed an invasive pneumococcal infection [28]. Regarding respiratory outcomes, FISMAN et al [27] found that prior receipt of pneumococcal vaccine was associated with a decreased risk of respiratory failure in a large cohort of adults with pneumonia.…”