Nichol K L
Medicine Service (III), VA Medical Center, University of Minnesota Medical School, Minneapolis 55417, USA.
Vaccine. 1999 Jul 30;17 Suppl 1:S91-3. doi: 10.1016/s0264-410x(99)00114-0.
Uncertainty regarding the benefits of pneumococcal vaccination may contribute to the under use of this vaccine. The present study was conducted to clarify the benefits of influenza and pneumococcal vaccinations during 3 influenza seasons among elderly persons with chronic lung disease. All elderly members of a large managed care organization with a prior diagnosis of chronic lung disease were included in a cohort that was followed over three influenza seasons (1993-1994, 1994-1995, and 1995-1996). Data obtained from the administrative data bases of the health care organization included baseline demographic and health characteristics, influenza vaccination status for each season, date of pneumococcal vaccination, and outcomes for each season including hospitalization for pneumonia and death. Cox proportional hazards regression and Poisson regression with repeated measures were used to compare the risk of outcomes among vaccinated and unvaccinated persons while controlling for covariates and confounders. During the three influenza seasons, influenza vaccination alone was associated with a 52% reduction (95% CI 18-72) in hospitalizations for pneumonia and a 70% reduction (95% CI 57-89) in death. Pneumococcal vaccination alone during the three influenza seasons was associated with a 27% reduction (95% CI 13-52) in hospitalizations for pneumonia and a 34% reduction (95% CI 6-54) in death. Both vaccinations together demonstrated additive benefits. When both vaccinations had been received, there was a 63% reduction (95% CI 29-80) in hospitalizations for pneumonia and an 81% reduction (95% CI 68-88) in death versus when neither had been received. These findings suggest pneumococcal vaccination is associated with substantial benefits for elderly persons with chronic lung disease.
肺炎球菌疫苗接种益处的不确定性可能导致该疫苗使用不足。本研究旨在明确在三个流感季节中，慢性肺病老年人接种流感疫苗和肺炎球菌疫苗的益处。一家大型管理式医疗组织中所有先前被诊断患有慢性肺病的老年成员被纳入一个队列，随访三个流感季节（1993 - 1994年、1994 - 1995年和1995 - 1996年）。从医疗保健组织的行政数据库中获取的数据包括基线人口统计学和健康特征、每个季节的流感疫苗接种状况、肺炎球菌疫苗接种日期以及每个季节的结局，包括肺炎住院和死亡情况。使用Cox比例风险回归和重复测量的泊松回归来比较接种疫苗和未接种疫苗者在控制协变量和混杂因素后的结局风险。在三个流感季节中，仅接种流感疫苗与肺炎住院率降低52%（95%可信区间18 - 72）和死亡率降低70%（95%可信区间57 - 89）相关。在三个流感季节中仅接种肺炎球菌疫苗与肺炎住院率降低27%（95%可信区间13 - 52）和死亡率降低34%（95%可信区间6 - 54）相关。两种疫苗一起接种显示出相加的益处。与两种疫苗都未接种相比，两种疫苗都接种时，肺炎住院率降低63%（95%可信区间29 - 80），死亡率降低81%（95%可信区间68 - 88）。这些发现表明，肺炎球菌疫苗接种对患有慢性肺病的老年人有显著益处。
