Dear Editor,

I read with interest the paper by Alfageme and colleagues (1) who investigated the efficacy of anti-pneumococcal vaccination in patients with COPD. To have new data in an area which has suffered from a surfeit of meta-analysis and even analysis of the meta-analysis is good and their results are quite clear. Although they do not specifically comment I presume that their primary end point was accumulative proportion of patients without pneumonia during the follow up period. There is no significant effect. Unfortunately, this clear result is then muddied by data dredging. Small subgroups of patients, those under 65 and those with severe COPD are extracted from the data and unsurprisingly are found to be significantly improved. The reliability of this reanalysis is at best dubious and probably should be reserved for building hypotheses to be tested in subsequent studies.

Where then does this leave the costly vaccination programme recommended by NICE? It should be urgently reconsidered, particularly as the reanalysis produced by Alfageme and colleagues suggest that the patients targeted by this programme, those over 65 years of age, may actually be harmed with 14% greater incidence of pneumonia in the active treatment group. Whilst statistically insignificant how can the national guidelines, which are supposed to be evidence based, fly in the face of such new evidence?

PROFESSOR ALYN H MORICE
Professor of Respiratory Medicine
Head of Division of Academic Medicine

References

1. Alfageme I, Vazquez R, Reyes N, et al. Clinical efficacy of anti- pneumococcal vaccination in patients with COPD. Thorax 2006;61:189-195.