No evidence that vaccination with a polysaccharide pneumococcal vaccine protects drug users against all-cause pneumonia

Lindenburg, Catharina E. A.; Langendam, Miranda; Benthem, Birgit H B van; Miedema, Frank; Coutinho, Roel A.

doi:10.1097/00002030-200107060-00017

Cited by 18 publications

(6 citation statements)

References 4 publications

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“…Seven additional studies on PPV‐23 and all‐cause pneumonia were identified. Three studies found no significant effect of PPV‐23 immunization [19,37,38], four found a protective effect [18,30,39,40], and the Uganda trial reported a harmful effect (Fig. 1b).…”

Section: Resultsmentioning

confidence: 99%

“…This issue can be very difficult to control for in observational studies and can only be eliminated in well‐designed randomized controlled trials. No study controlled for all known risk factors and some, such as the studies by Lindenburg et al [37], López‐Palomo et al [39] and Navin et al [38], controlled only for a few or none. Reasons for the nonreceipt of PPV‐23 were known in only a few of the studies.…”

Section: Discussionmentioning

confidence: 99%

“…There was considerable heterogeneity in design, size and quality among the studies. Notably, the Lindenburg et al study [37] included only 48 drug users and the study by Navin et al [38], the aim of which was to search for risk factors for community-acquired pneumonia (CAP), also included patients with Pneumocystis carinii pneumonia. The extent of confounder control is summarized in Table 2.…”

Section: All-cause Pneumoniamentioning

confidence: 99%

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The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

et al. 2010

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ObjectiveThe effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing pneumococcal disease in HIV-infected people is a subject of debate. We reviewed the clinical evidence for recommending PPV-23 for use in HIV-infected patients. MethodsA systematic search of peer-reviewed publications (EMBASE, the Cochrane Library, and PubMed/ BioMed Central), the Internet and grey literature was conducted. Three hundred and eighteen documents were reviewed. Studies reporting risk estimates for all-cause pneumonia, allpneumococcal disease, and/or invasive pneumococcal disease after PPV-23 immunization in HIV-infected adults were included. ResultsWe identified one randomized trial and 15 observational studies. While the randomized trial found a 60% increased risk of all-cause pneumonia among vaccinees, 11 of the 15 observational studies found various degrees of disease protection associated with PPV-23 immunization. However, most studies suffered from limited confounder control in their multivariate analyses, despite study data suggesting substantial differences between the characteristics of exposed and unexposed individuals. ConclusionsThe current clinical evidence provides only moderate support for PPV-23 immunization of HIVinfected adults. More data are needed on the efficacy of newer conjugated pneumococcal vaccines, which may be more immunogenic and could potentially replace PPV-23 in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: All-cause Pneumoniamentioning

confidence: 99%

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The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

et al. 2010

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“…Several cohort and casecontrol studies have found that the vaccine produces a beneficial effect by decreasing the incidence of IPD, particularly in patients receiving HAART and with higher CD4 counts but also in patients with CD4 counts below 200 cells/mL [4,6,7,[12][13][14]. In contrast, other studies, including the only published randomized double-blind placebo-controlled study, have not found a clear benefit of the 23-valent PPV in preventing IPD in HIV-infected patients [10,[15][16][17][18]. In any case, because the impact of pneumococcal infections on morbidity and mortality remains high, vaccination with 23-valent PPV is currently recommended in HIV-infected patients, particularly in those with CD4 counts 4200 cells/mL [19,20].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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.

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“…Antibodies to capsular polysaccharides confer protective immunity to S. pneumoniae, and this is the basis for the use of the currently licensed 23-valent pneumococcal polysaccharide vaccine. This vaccine prevents invasive pneumococcal disease caused by vaccine serotypes among immunocompetent persons [Centers for Disease Control and Prevention, 1997]; its effectiveness in preventing invasive disease among immunosuppressed persons, such as those infected by HIV, is less clear [Lindenburg et al, 2001]. Therefore, a case-control study conducted by Gebo et al [1996] suggested an effectiveness of 78% for prevention of pneumococcal bacteremia among HIV-infected patients with CD4þ cell counts greater than 200 cells/ml, but did not find effectiveness among persons with lower CD4þ cell counts.…”

Section: Introductionmentioning

confidence: 99%

Pneumonia in HIV‐infected patients in the HAART era: Incidence, risk, and impact of the pneumococcal vaccination

López-Palomo

Martín-Zamorano

Benítez

et al. 2004

Journal of Medical Virology

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The objective of this study was to assess the factors implicated in an increased or decreased risk of pneumonia, with particular attention to the response to highly active antiretroviral therapy (HAART) and the effect of the polysaccharide 23-valent pneumococcal vaccination in 300 human immunodeficiency virus (HIV)-infected adults followed-up for a median of 35.6 months. Pneumococcal pneumonia occurred in 12 patients and all bacterial pneumonia (pneumonia caused by Streptococcus pneumoniae or other bacteria, as well as those with negative cultures but presumably bacterial in origin) in 40 patients. In the univariate analysis, immunodepressed patients (defined as those with less than 200 CD4+ T cell/microl), those without immunological response to HAART (defined as an increase of 25% of CD4+ T lymphocyte count), patients with previous admissions to hospital and those with cotrimoxazole or Mycobacterium avium intracellulare prophylaxis showed a higher incidence of both pneumococcal and all bacterial pneumonia. Multivariate analysis demonstrated that the presence of pneumococcal pneumonia was associated with a CD4+ lymphocyte count at the time of HIV diagnosis <200 cells/microl. The multivariate model that was more valid for prediction of all bacterial pneumonia included a CD4+ T cell count <200 cells/microl and absence of immunological response to HAART. Only in patients with a baseline CD4+ T cell count lower than 200/microl and immunological response to HAART, a near significant lower incidence of all bacterial pneumonia was observed after vaccination. Thus, these results do not support an important additional protective effect of 23-valent pneumococcal vaccine in HIV-patients with immunological response to HAART.

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No evidence that vaccination with a polysaccharide pneumococcal vaccine protects drug users against all-cause pneumonia

Cited by 18 publications

References 4 publications

The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

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

Pneumonia in HIV‐infected patients in the HAART era: Incidence, risk, and impact of the pneumococcal vaccination

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