Clinical efficacy of anti-pneumococcal vaccination in patients with COPD
- I Alfageme1,
- R Vazquez2,
- N Reyes1,
- J Muñoz1,
- A Fernández2,
- M Hernandez1,
- M Merino1,
- J Perez1,
- J Lima1
- 1Pneumology Section, Valme University Hospital, Seville, Spain
- 2Research Unit, Valme University Hospital, Seville, Spain
- Correspondence to:
Dra I Alfageme
Pneumology Section, Valme University Hospital, 41014 Seville, Spain;
- Received 2 March 2005
- Accepted 28 September 2005
- Published Online First 14 October 2005
Background: A study was undertaken to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV) in immunocompetent patients with chronic obstructive pulmonary disease (COPD).
Methods: A randomised controlled trial was carried out in 596 patients with COPD of mean (SD) age 65.8 (9.7) years, 298 of whom received PPV. The main outcome was radiographically proven community acquired pneumonia (CAP) of pneumococcal or unknown aetiology after a mean period of 979 days (range 20–1454).
Results: There were 58 first episodes of CAP caused by pneumococcus or of unknown aetiology, 25 in the intervention group and 33 in the non-intervention group. Kaplan-Meier survival curves for CAP did not show significant differences between the 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 to 54; p = 0.333). In the subgroup aged <65 years the efficacy of PPV was 76% (95% CI 20 to 93; p = 0.013), while in those with severe functional obstruction (forced expiratory volume in 1 second <40%) it was 48% (95% CI −7 to 80; p = 0.076). In younger patients with severe airflow obstruction the efficacy was 91% (95% CI 35 to 99; p = 0.002). There were only five cases of non-bacteraemic pneumococcal CAP, all in the non-intervention group (log rank test = 5.03; p = 0.025). Multivariate analysis gave a hazard ratio for unknown and pneumococcal CAP in the vaccinated group, adjusted for age, of 0.20 (95% CI 0.06 to 0.68; p = 0.01).
Conclusions: PPV is effective in preventing CAP in patients with COPD aged less than 65 years and in those with severe airflow obstruction. No differences were found among the other groups of patients with COPD.
- CAP, community acquired pneumonia
- COPD, chronic obstructive pulmonary disease
- FEV1, forced expiratory volume in 1 second
- PPV, pneumococcal polysaccharide vaccine
Published Online First 14 October 2005
Supported by two grants of SEPAR (Sociedad Española de Neumología y Cirugía Torácica) and SAS (Servicio Andaluz de Salud: 53/99).
Competing interests: none declared.