Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 1 (1), CD001390

Pneumococcal Vaccines for Preventing Pneumonia in Chronic Obstructive Pulmonary Disease

Affiliations
Review

Pneumococcal Vaccines for Preventing Pneumonia in Chronic Obstructive Pulmonary Disease

Julia Ae Walters et al. Cochrane Database Syst Rev.

Abstract

Background: People with chronic obstructive pulmonary disease (COPD) are at increased risk of pneumococcal disease, especially pneumonia, as well as acute exacerbations with associated morbidity and healthcare costs.

Objectives: To determine the efficacy of injectable pneumococcal vaccination for preventing pneumonia in persons with COPD.

Search methods: We searched the Cochrane Airways COPD Trials Register and the databases CENTRAL, MEDLINE and Embase, using prespecified terms. Searches are current to November 2016.

Selection criteria: We included randomised controlled trials (RCT) comparing injectable pneumococcal polysaccharide vaccine (PPV) or pneumococcal conjugated vaccine (PCV) versus a control or alternative vaccine type in people with COPD.

Data collection and analysis: We used standard Cochrane methodological procedures. For meta-analyses, we subgrouped studies by vaccine type.

Main results: For this update, we added five studies (606 participants), meaning that the review now includes a total of 12 RCTs involving 2171 participants with COPD. Average age of participants was 66 years, male participants accounted for 67% and mean forced expiratory volume in one second (FEV1) was 1.2 L (five studies), 54% predicted (four studies). We assessed risks of selection, attrition and reporting bias as low, and risks of performance and detection bias as moderate.Compared with control, the vaccine group had a lower likelihood of developing community-acquired pneumonia (CAP) (odds ratio (OR) 0.62, 95% confidence interval (CI) 0.43 to 0.89; six studies, n = 1372; GRADE: moderate), but findings did not differ specifically for pneumococcal pneumonia (Peto OR 0.26, 95% CI 0.05 to 1.31; three studies, n = 1158; GRADE: low). The number needed to treat for an additional beneficial outcome (NNTB) (preventing one episode of CAP) was 21 (95% CI 15 to 74). Mortality from cardiorespiratory causes did not differ between vaccine and control groups (OR 1.07, 95% CI 0.69 to 1.66; three studies, n = 888; GRADE: moderate), nor did all-cause mortality differ (OR 1.00, 95% CI 0.72 to 1.40; five studies, n = 1053; GRADE: moderate). The likelihood of hospital admission for any cause, or for cardiorespiratory causes, did not differ between vaccine and control groups. Vaccination significantly reduced the likelihood of a COPD exacerbation (OR 0.60, 95% CI 0.39 to 0.93; four studies, n = 446; GRADE: moderate). The NNTB to prevent a patient from experiencing an acute exacerbation was 8 (95% CI 5 to 58). Only one study (n = 181) compared the efficacy of different vaccine types - 23-valent PPV versus 7-valent PCV - and reported no differences for CAP, all-cause mortality, hospital admission or likelihood of a COPD exacerbation, but investigators described a greater likelihood of some mild adverse effects of vaccination with PPV-23.

Authors' conclusions: Injectable polyvalent pneumococcal vaccination provides significant protection against community-acquired pneumonia, although no evidence indicates that vaccination reduced the risk of confirmed pneumococcal pneumonia, which was a relatively rare event. Vaccination reduced the likelihood of a COPD exacerbation, and moderate-quality evidence suggests the benefits of pneumococcal vaccination in people with COPD. Evidence was insufficient for comparison of different pneumococcal vaccine types.

Conflict of interest statement

Richard Wood‐Baker has received financial support for his research activities and expenses for presentation; full details are available at http://airways.cochrane.org/more‐about‐us

Julia Walters has received financial support for research and expenses for presentation; full details are available at http://airways.cochrane.org/more‐about‐us.

Joanne Tang has no known conflicts of interest.

Phillippa Poole has no known conflicts of interest.

Figures

Figure 1
Figure 1
In the control group, 608 out of 1000 people had one or more exacerbations over 6 to 24 months, compared with 482 (95% CI 377 to 591) out of 1000 for the active treatment group.
Figure 2
Figure 2
Study flow diagram.
Figure 3
Figure 3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figure 4
Figure 4
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figure 5
Figure 5
Forest plot of comparison: 1 Pneumococcal vaccine versus control, outcome: 1.1 Community‐acquired pneumonia: at least 1 episode.
Figure 6
Figure 6
Forest plot of comparison: 1 Pneumococcal vaccine versus control, outcome: 1.4 Death from cardiorespiratory causes.
Figure 7
Figure 7
Forest plot of comparison: 1 Pneumococcal vaccine versus control, outcome: 1.1 At least 1 COPD exacerbation.
Analysis 1.1
Analysis 1.1
Comparison 1 Pneumococcal vaccine versus control, Outcome 1 Community‐acquired pneumonia: at least 1 episode.
Analysis 1.2
Analysis 1.2
Comparison 1 Pneumococcal vaccine versus control, Outcome 2 Community‐acquired pneumonia: rate per person‐year.
Analysis 1.3
Analysis 1.3
Comparison 1 Pneumococcal vaccine versus control, Outcome 3 Pneumococcal pneumonia: at least 1 episode.
Analysis 1.4
Analysis 1.4
Comparison 1 Pneumococcal vaccine versus control, Outcome 4 Death from cardiorespiratory causes.
Analysis 1.5
Analysis 1.5
Comparison 1 Pneumococcal vaccine versus control, Outcome 5 Death from all causes.
Analysis 1.6
Analysis 1.6
Comparison 1 Pneumococcal vaccine versus control, Outcome 6 Hospital admission, any cause: at least 1 episode.
Analysis 1.7
Analysis 1.7
Comparison 1 Pneumococcal vaccine versus control, Outcome 7 Hospital admission: cardiorespiratory‐related.
Analysis 1.8
Analysis 1.8
Comparison 1 Pneumococcal vaccine versus control, Outcome 8 Hospital admission: all‐cause.
Analysis 1.9
Analysis 1.9
Comparison 1 Pneumococcal vaccine versus control, Outcome 9 ED visit, any cause: at least 1 episode.
Analysis 1.10
Analysis 1.10
Comparison 1 Pneumococcal vaccine versus control, Outcome 10 At least 1 COPD exacerbation.
Analysis 1.11
Analysis 1.11
Comparison 1 Pneumococcal vaccine versus control, Outcome 11 COPD exacerbation rate.
Analysis 1.12
Analysis 1.12
Comparison 1 Pneumococcal vaccine versus control, Outcome 12 COPD exacerbations: rate/person‐year.
Analysis 1.13
Analysis 1.13
Comparison 1 Pneumococcal vaccine versus control, Outcome 13 Lung function: FEV1 (L).
Analysis 1.14
Analysis 1.14
Comparison 1 Pneumococcal vaccine versus control, Outcome 14 Quality of life: SGRQ overall.
Analysis 2.1
Analysis 2.1
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 1 Community‐acquired pneumonia: at least 1 episode.
Analysis 2.2
Analysis 2.2
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 2 Death from all causes.
Analysis 2.3
Analysis 2.3
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 3 Hospital admission, any cause: at least 1 episode.
Analysis 2.4
Analysis 2.4
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 4 Acute exacerbation COPD.
Analysis 2.5
Analysis 2.5
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 5 Adverse effects.
Analysis 3.1
Analysis 3.1
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 1 Pneumonia by lung function at baseline.
Analysis 3.2
Analysis 3.2
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 2 Hospital admission, any cause: by follow‐up periods.
Analysis 3.3
Analysis 3.3
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 3 Hospital admission, cardiorespiratory‐related: by follow‐up periods.
Analysis 3.4
Analysis 3.4
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 4 Emergency department visit, any cause: by follow‐up period.
Analysis 3.5
Analysis 3.5
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 5 Emergency visits (by cause).
Analysis 3.6
Analysis 3.6
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 6 At least 1 COPD exacerbation: varying follow‐up.

Update of

Comment in

Similar articles

See all similar articles

Cited by 8 PubMed Central articles

See all "Cited by" articles

MeSH terms

Substances

Feedback