Primary Care Service of Tarragona-Valls, Institut Catalá de la Salut, Tarragona, Spain.
Hum Vaccin Immunother. 2012 May;8(5):639-44. doi: 10.4161/hv.19466. Epub 2012 May 1.
The effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) is controversial, especially among people with high-risk conditions. This study assessed the clinical effectiveness of vaccination against pneumonia among patients with chronic pulmonary diseases.
We conducted a population-based case-control study including 96 non-immunocompromised patients with clinical diagnosis of chronic pulmonary disease (chronic bronchitis, emphysema and/or asthma), aged 50 y or older, with radiographically confirmed pneumococcal pneumonia (19 bacteremic and 77 nonbacteremic cases) and 192 outpatient control subjects with similar chronic pulmonary diseases (matched by primary care center, age, sex and main comorbidity). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for by underlying conditions.
Pneumococcal vaccination did not alter significantly the risk of overall pneumococcal pneumonia [adjusted OR: 0.71; 95% confidence interval (CI): 0.37-1.39]. Point estimates of vaccine effectiveness was the maximum against bacteremic pneumococcal pneumonia due to vaccine-serotypes, although neither reached statistical significance (adjusted OR: 0.51; 95% CI: 0.03-8.19). Vaccination pointed to a smaller benefit against nonbacteremic pneumococcal pneumonia (adjusted OR: 0.66; 95% CI: 0.33-1.34). Pneumococcal vaccination was associated with a non-statistically significant reduction in the risk of all pneumococcal pneumonia among persons 75 y or older (adjusted OR: 0.45; 95% CI: 0.16-1.27), but no apparent protective effect emerged among people 50-74 y (adjusted OR: 1.48; 95% CI: 0.62-3.56).
The effectiveness of the PPV-23 in preventing pneumonia among patients with chronic pulmonary disease is uncertain. Our results point to PPV-23 having little or null effect against pneumococcal pneumonia in such patients, but definitive conclusions cannot be established based on our data.
23 价多糖肺炎球菌疫苗（PPV-23）的有效性存在争议，尤其是在高危人群中。本研究评估了肺炎球菌疫苗接种对慢性肺部疾病患者肺炎的临床效果。
我们进行了一项基于人群的病例对照研究，纳入了 96 名非免疫功能低下的临床诊断为慢性肺部疾病（慢性支气管炎、肺气肿和/或哮喘）的患者，年龄 50 岁或以上，影像学证实为肺炎球菌性肺炎（19 例菌血症和 77 例非菌血症病例）和 192 名门诊对照患者具有相似的慢性肺部疾病（按初级保健中心、年龄、性别和主要合并症匹配）。使用条件逻辑回归计算接种疫苗的调整比值比（OR），并控制潜在疾病。
肺炎球菌疫苗接种并未显著改变总体肺炎球菌性肺炎的风险[调整后的 OR：0.71；95%置信区间（CI）：0.37-1.39]。疫苗血清型引起的菌血症性肺炎球菌肺炎的疫苗有效性估计值最高，但均无统计学意义（调整后的 OR：0.51；95%CI：0.03-8.19）。疫苗接种对非菌血症性肺炎球菌肺炎的益处较小（调整后的 OR：0.66；95%CI：0.33-1.34）。肺炎球菌疫苗接种与 75 岁或以上人群所有肺炎球菌性肺炎风险的降低相关，但无统计学意义（调整后的 OR：0.45；95%CI：0.16-1.27），但在 50-74 岁人群中未出现明显的保护作用（调整后的 OR：1.48；95%CI：0.62-3.56）。
目前尚不确定 23 价多糖肺炎球菌疫苗（PPV-23）预防慢性肺部疾病患者肺炎的效果。我们的结果表明，PPV-23 对这类患者的肺炎球菌性肺炎几乎没有或没有影响，但基于我们的数据，无法得出明确的结论。
