Sims R V, Steinmann W C, McConville J H, King L R, Zwick W C, Schwartz J S
Department of Medicine, University of Pennsylvania, Philadelphia.
Ann Intern Med. 1988 May;108(5):653-7. doi: 10.7326/0003-4819-108-5-653.
The effectiveness of pneumococcal vaccine in the immunocompetent elderly remains controversial. We report the results of a multicenter, case-control study of 244 controls and 122 patients, aged 55 years and older, hospitalized during a 5-year period with pneumococcal bacteremia, meningitis, or other bacteriologically confirmed pneumococcal infection. Two controls per patient were matched on the basis of admission date, hospital records, and underlying diseases. All subjects were selected without knowledge of immunization status with pneumococcal vaccine, and were excluded if there was evidence for immunosuppression due to disease or iatrogenic causes. The clinical effectiveness of the vaccine was calculated to be 70% (95% confidence intervals [CI], 37% to 86%) in this population, based on a Mantel-Haenszel point estimate of the odds ratio of 0.30 (95% CI, 0.14% to 0.63%; P less than 0.005). The clinical effectiveness of pneumococcal vaccine in preventing pneumococcal infection in the immunocompetent elderly approximates the vaccine's effectiveness in the general immunocompetent population.
肺炎球菌疫苗在免疫功能正常的老年人中的有效性仍存在争议。我们报告了一项多中心病例对照研究的结果，该研究纳入了244名对照者和122名年龄在55岁及以上的患者，这些患者在5年期间因肺炎球菌血症、脑膜炎或其他细菌学确诊的肺炎球菌感染而住院。根据入院日期、医院记录和基础疾病，为每位患者匹配两名对照者。所有受试者在选择时均不知其肺炎球菌疫苗免疫状态，若有因疾病或医源性原因导致免疫抑制的证据则被排除。基于Mantel-Haenszel点估计的比值比为0.30（95%置信区间[CI]，0.14%至0.63%；P<0.005），该疫苗在这一人群中的临床有效性计算为70%（95%CI，37%至86%）。肺炎球菌疫苗在预防免疫功能正常的老年人肺炎球菌感染方面的临床有效性近似于其在一般免疫功能正常人群中的有效性。
