Diao Wen-Qi, Shen Ning, Yu Pan-Xi, Liu Bei-Bei, He Bei
Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China.
Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China.
Vaccine. 2016 Mar 18;34(13):1496-1503. doi: 10.1016/j.vaccine.2016.02.023. Epub 2016 Feb 17.
Data on the efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing adult community-acquired pneumonia (CAP) among the target population of individuals aged over 65 years and high-risk individuals aged 19-64 years are conflicting. As the Advisory Committee on Immunization Practices (ACIP) has recently demonstrated PPV-23 is likely beneficial to immunocompromised adults by the Grading, Assessment, Development, and Evaluation (GRADE) framework, we conducted meta-analysis to examine its efficacy in an immunocompetent population.
We searched the PUBMED, EMBASE, and Cochrane Library databases for randomized trials. Overall relative risks (RRs) with 95% confidential intervals (CIs) were calculated, and the Cochrane Q test (p, I(2)) was performed. Outcomes were assessed by the GRADE framework.
Seven randomized trials involving 156,010 participants were included in this meta-analysis. High-quality evidence revealed that PPV-23 was weakly associated with the prevention of all-cause pneumonia ([RR] 0.87, [95%CI] 0.76-0.98, p=0.11, I(2)=43%), especially among the target population ([RR] 0.72, [95%CI] 0.69-0.94, p=0.58 I(2)=0%), the elderly group aged over 40 years ([RR] 0.80, [95%CI] 0.69-0.94) and the Japanese population ([RR] 0.72, [95%CI] 0.59-0.88, p=0.24, I(2)=30%). The target population included adults aged over 65 years and patients at high risk of pneumonia due to chronic lung disease, chronic obstructive pulmonary disease or living in a nursing home. Protective trends of PPV-23 in the outcomes of pneumococcal pneumonia ([RR] 0.54, [95%CI] 0.18-1.65, p=0.01, I(2)=77%) and mortality due to pneumonia ([RR] 0.67, [95%CI] 0.43-1.04, p=0.67, I(2)=0%) were observed, although the results were statistically insignificant, possibly due to the small number of trials included. PPV-23 did not prevent all-cause mortality ([RR] 1.04, [95%CI] 0.87-1.24, p=0.95, I(2)=0%).
PPV-23 provided weak protection against all-cause pneumonia in an immunocompetent population, especially among the target population. The additional benefit of PPV-23 in preventing CAP further supports its application in the target population.
关于23价肺炎球菌多糖疫苗（PPV-23）在预防65岁以上目标人群及19-64岁高危个体的成人社区获得性肺炎（CAP）方面的疗效数据存在冲突。由于免疫实践咨询委员会（ACIP）最近通过分级、评估、制定和评价（GRADE）框架表明PPV-23可能对免疫功能低下的成年人有益，我们进行了荟萃分析以研究其在免疫功能正常人群中的疗效。
我们在PUBMED、EMBASE和Cochrane图书馆数据库中检索随机试验。计算总体相对风险（RRs）及95%置信区间（CIs），并进行Cochrane Q检验（p，I(2)）。通过GRADE框架评估结果。
本荟萃分析纳入了7项涉及156,010名参与者的随机试验。高质量证据显示，PPV-23与预防全因性肺炎的关联较弱（[RR] 0.87，[95%CI] 0.76-0.98，p=0.11，I(2)=43%），尤其是在目标人群中（[RR] 0.72，[95%CI] 0.69-0.94，p=0.58，I(2)=0%）、40岁以上老年人群（[RR] 0.80，[95%CI] 0.69-0.94）以及日本人群中（[RR] 0.72，[95%CI] 0.59-0.88，p=0.24，I(2)=30%）。目标人群包括65岁以上成年人以及因慢性肺病、慢性阻塞性肺疾病或居住在养老院而有肺炎高危风险的患者。尽管结果在统计学上不显著，可能是由于纳入试验数量较少，但观察到PPV-23在肺炎球菌肺炎结局（[RR] 0.54，[95%CI] 0.18-1.65，p=0.01，I(2)=77%）和肺炎导致的死亡率方面（[RR] 0.67，[95%CI] 0.43-1.04，p=0.67，I(2)=0%）有保护趋势。PPV-23不能预防全因死亡率（[RR] 1.04，[95%CI] 0.87-1.24，p=0.95，I(2)=0%）。
PPV-23在免疫功能正常人群中对全因性肺炎提供了较弱的保护，尤其是在目标人群中。PPV-23在预防CAP方面的额外益处进一步支持了其在目标人群中的应用。
