Vila-Corcoles Angel, Ochoa-Gondar Olga, Rodriguez-Blanco Teresa, de Diego-Cabanes Cinta, Satue-Gracia Eva, Vila-Rovira Angel, Torrente Fraga Cristina
Primary Care Service "Camp de Tarragona", Institut Catala de la Salut, Tarragona, Spain.
Primary Care Service "Camp de Tarragona", Institut Catala de la Salut, Tarragona, Spain.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1577-84. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.047. Epub 2014 Mar 19.
Cerebrovascular benefits using the 23-valent pneumococcal polysaccharide vaccine (PPV23) are controversial. This study assessed clinical effectiveness of PPV23 in preventing ischemic stroke in people older than 60 years.
We conducted a population-based cohort study involving 27,204 individuals of 60 years or older in Tarragona, Spain, who were prospectively followed from December 01, 2008, until November 30, 2011. Outcomes were neuroimaging-confirmed ischemic stroke, 30-day mortality from stroke, and all-cause death. Pneumococcal vaccination effectiveness was evaluated by Cox regression analyses, estimating hazard ratios (HRs) adjusted for age, sex, comorbidities, and influenza vaccine status.
Cohort members were followed for a total of 76,033 person-years, of which 29,065 were for vaccinated subjects. Overall, 343 cases of stroke, 45 deaths from stroke, and 2465 all-cause deaths were observed. Pneumococcal vaccination did not alter the risk of stroke (multivariable HR: 1.04; 95% confidence interval [CI]: .83-1.30; P=.752), death from stroke (HR: 1.14; 95% CI: .61-2.13; P=.686), and all-cause death (HR: .97; 95% CI: .89-1.05; P=.448). In analyses focused on people with and without a history of cerebrovascular disease, the PPV23 did not emerge effective in preventing any analyzed event, but influenza vaccine emerged independently associated with a reduced risk of death from stroke (HR: .51; 95% CI: .28-.93; P=.029) and all-cause death (HR: .73; 95% CI: .67-.81; P<.001).
Our data support that the PPV23 does not provide benefit against ischemic stroke, but it also supports a beneficial effect of influenza vaccine in reducing specific- and all-cause mortality risk in the general population older than 60 years.
使用23价肺炎球菌多糖疫苗（PPV23）对脑血管的益处存在争议。本研究评估了PPV23在预防60岁以上人群缺血性卒中方面的临床效果。
我们在西班牙塔拉戈纳开展了一项基于人群的队列研究，纳入了27204名60岁及以上的个体，从2008年12月1日起对他们进行前瞻性随访，直至2011年11月30日。结局指标为经神经影像学证实的缺血性卒中、卒中后30天死亡率和全因死亡。通过Cox回归分析评估肺炎球菌疫苗接种的有效性，估计调整了年龄、性别、合并症和流感疫苗接种状况后的风险比（HR）值。
队列成员总共随访了76033人年，其中接种疫苗的受试者随访了29065人年。总体而言，观察到343例卒中病例、45例卒中死亡和2465例全因死亡。肺炎球菌疫苗接种并未改变卒中风险（多变量HR：1.04；95%置信区间[CI]：. .83 - 1.30；P = .752）、卒中死亡风险（HR：1.14；95% CI：.61 - 2.13；P = .686）和全因死亡风险（HR：.97；95% CI：.89 - 1.05；P = .448）。在针对有和没有脑血管疾病病史人群的分析中，PPV23在预防任何分析事件方面均未显示出有效性，但流感疫苗与卒中死亡风险降低（HR：.51；95% CI：.28 -.93；P = .029）和全因死亡风险降低（HR：.73；95% CI：.67 -.81；P < .001）独立相关。
我们的数据支持PPV23对缺血性卒中无益处，但也支持流感疫苗在降低60岁以上普通人群特定原因和全因死亡风险方面具有有益作用。
