Clinical efficacy of anti-pneumococcal vaccination in patients with COPD

Inmaculada Alfageme ^1*, Rafael Vazquez ¹, Nuria Reyes ¹, Jesús Muñoz ¹, Ana Fernández ¹, Manuel Hernández ¹, Mercedes Merino ¹, Jose Pérez ¹ and Jorge Lima ¹

¹ Valme University Hospital, Spain

^* To whom correspondence should be addressed. E-mail: ialfageme{at}separ.es.

Accepted 28 September 2005

Abstract

Objective: The aim was to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV) among immunocompetent patients with chronic obstructive pulmonary disease (COPD).

Methods: A randomized, controlled trial was carried out with 596 COPD patients (65.8±9.7 years), of which 298 received PPV. The main outcome was a radiographically proven community-acquired pneumonia (CAP) of pneumococcal or unknown aetiology, after a mean period of 979 days (range 20-1454 days).

Results: There were 58 first episodes of CAP caused by pneumococcus, or of unknown aetiology, with 25 in the intervention and 33 in the non-intervention group. Kaplan-Meier survival curves for CAP did not show significant differences between intervention and non-intervention arms (log-rank test=1.15, p=0.28), in the whole group of patients, The efficacy of PPV in all patients was 24% (95%-CI, -24, 54, p=0.333). In the sub-group <65 years it was 76% (95%-CI, 20, 93; p=0.013), while in those with severe functional obstruction (FEV1< 40%) it was 48% (95%-CI, -7, 80; p=0.076). In younger patients with a severe airflow obstruction, the efficacy was 91% (95%-CI, 35, 99; p=0.002). There were only 5 non-bacteraemic pneumococcal CAP, all being in the non-intervention group (Log-Rank test=5.03; p=0.025). A multivariate analysis showed a hazard ratio for unknown and pneumococcal CAP in the vaccinated group, adjusted for age, of 0.20 (95%-CI, 0.06, 0.68; p=0.01).

Conclusions: PPV was effective in avoiding CAP in COPD patients younger than 65 years, and in patients with a severe airflow obstruction. No differences amongst the other groups of COPD patients were found.

Keywords: COPD, pneumoccocal vaccine, pneumonia

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