Pneumococcal Infection and Immunologic Response to Pneumococcal Vaccine in Chronic Obstructive Pulmonary Disease

Davis, Alison F.; Aranda, Conrado P.; Schiffman, Gerald; Christianson, Lynn C.

doi:10.1378/chest.92.2.204

Cited by 94 publications

(44 citation statements)

References 29 publications

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“…The incidence of pneumonia (0.096 episodes/ patient/ year) with CLD in this study was twice as higher as those of previous cohort studies of COPD patients (0.047 to 0.055 episodes/ patient/ year) [14,17]. No significant difference was found in the number of patients developing pneumonia between the PV+IV group and the IV group (Table 1).…”

Section: Resultscontrasting

confidence: 56%

“…PV is, therefore, recommended for these patients [11][12][13]. Although the previous studies reported that PV is not effective in preventing pneumonia or acute exacerbation in patients with COPD [14][15][16], a recent, prospective study demonstrated an effect of PV in preventing pneumonia in such patients with aged less than age of 65 years of age with severe airflow obstruction [17]. In addition, a retrospective study previously reported the additive effects of PV with influenza vaccine (IV) in the reduction of hospitalization 3 stays and death among elderly persons with CLD [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

Furumoto

Ohkusa

Chen

et al. 2008

Vaccine

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To determine the clinical efficacy of combined vaccination with 23-valent pneumococcal vaccine (PV) and influenza vaccine (IV) against pneumonia and acute exacerbation of chronic lung diseases (CLD), we conducted an open-label, randomized, controlled study among 167 adults with CLD over a 2 year period. Subjects were randomly assigned to a PV+IV group (n=87) or an IV group (n=80), respectively. The number of patients with CLD experiencing infectious acute exacerbation (P=0.022), but not pneumonia (P=0.284), was significantly lower in the PV+IV group compared with the IV group. When these subjects were divided into subgroups, an additive effect of PV with IV in preventing infectious acute exacerbation was significant only in patients with chronic obstructive pulmonary diseases (P=0.037). In patients with CLD, the Kaplan-Meier survival curves demonstrated a significant difference for infectious acute exacerbation (P=0.016) between the two groups. An additive effect of PV with IV on infectious acute exacerbation was found during the first year after vaccination (P=0.019), but not during the second year (P=0.342), and was associated with serotype-specific immune response in sera of these patients who used PV during the same period.

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Section: Resultscontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

Furumoto

Ohkusa

Chen

et al. 2008

Vaccine

View full text Add to dashboard Cite

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“…We included 22 trials, described in 18 reports, that met our inclusion criteria (Table 1). [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] An overview of the study characteristics is given in Table 1, with further details in Appendix 2 (available at www.cmaj.ca/cgi/content/full/180/1/48/DC2).…”

Section: Discussionmentioning

confidence: 99%

“…Combined RRs from random-effects meta-analyses, without trial quality being taken into account, indicated beneficial effects of the vaccine on presumptive pneumococcal pneumo- 39 Davis et al 30 Relative risk 0.125 0.5 1 2 8…”

Section: Meta-analysesmentioning

confidence: 99%

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Efficacy of pneumococcal vaccination in adults: a meta-analysis

Huss¹,

Scott²,

Stuck³

et al. 2009

Canadian Medical Association Journal

362

254

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Background: Clinical trials and meta-analyses have produced conflicting results of the efficacy of unconjugated pneumococcal polysaccharide vaccine in adults. We sought to evaluate the vaccine's efficacy on clinical outcomes as well as the methodologic quality of the trials. Methods:We searched several databases and all bibliographies of reviews and meta-analyses for clinical trials that compared pneumococcal polysaccharide vaccine with a control. We examined rates of pneumonia and death, taking the methodologic quality of the trials into consideration. Results:We included 22 trials involving 101 507 participants: 11 trials reported on presumptive pneumococcal pneumonia, 19 on all-cause pneumonia and 12 on allcause mortality. The current 23-valent vaccine was used in 8 trials. The relative risk (RR) was 0.64 (95% confidence interval [CI] 0.43-0.96) for presumptive pneumococcal pneumonia and 0.73 (95% CI 0.56-0.94) for all-cause pneumonia. There was significant heterogeneity between the trials reporting on presumptive pneumonia (I 2 = 74%, p < 0.001) and between those reporting on all-cause pneumonia (I 2 = 90%, p < 0.001). The RR for all-cause mortality was 0.97 (95% CI 0.87-1.09), with moderate heterogeneity between trials (I 2 = 44%, p = 0.053). Trial quality, especially regarding double blinding, explained a substantial proportion of the heterogeneity in the trials reporting on presumptive pneumonia and all-cause pneumonia. There was little evidence of vaccine protection in trials of higher methodologic quality (RR 1.20, 95% CI 0.75-1.92, for presumptive pneumonia; and 1.19, 95% CI 0.95-1.49, for allcause pneumonia in double-blind trials; p for heterogeneity > 0.05). The results for all-cause mortality in double-blind trials were similar to those in all trials combined. There was little evidence of vaccine protection among elderly patients or adults with chronic illness in analyses of all trials (RR 1.04, 95% CI 0.78-1.38, for presumptive pneumococcal pneumonia; 0.89, 95% CI 0.69-1.14, for all-cause pneumonia; and 1.00, 95% CI 0.87-1.14, for all-cause mortality).Interpretation: Pneumococcal vaccination does not appear to be effective in preventing pneumonia, even in populations for whom the vaccine is currently recommended.

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The Health and Economic Benefits Associated With Pneumococcal Vaccination of Elderly Persons With Chronic Lung Disease

Nichol¹,

Baken²,

Wuorenma³

et al. 1999

Arch Intern Med

265

101

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Pneumococcal Infection and Immunologic Response to Pneumococcal Vaccine in Chronic Obstructive Pulmonary Disease

Cited by 94 publications

References 29 publications

Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

Efficacy of pneumococcal vaccination in adults: a meta-analysis

The Health and Economic Benefits Associated With Pneumococcal Vaccination of Elderly Persons With Chronic Lung Disease

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