Jennie Johnstone, MD
Is pneumococcal vaccination effective for various clinical outcomes in adults?
Included studies compared pneumococcal polysaccharide vaccine with placebo, other vaccines, or no intervention (control). Studies of children; evaluation of antibody responses only or pneumococcal polysaccharide vaccines as a booster after conjugate pneumococcal vaccine; or animal, laboratory, and observational intervention studies were excluded. Outcomes were definitive pneumococcal pneumonia, presumptive pneumococcal pneumonia, all-cause pneumonia, bacteremia or invasive pneumococcal disease, bronchitis, all-cause mortality, pneumonia mortality, and mortality from pneumococcal infection.
MEDLINE (1966 to May 2007), EMBASE/Excerpta Medica (1974 to May 2007), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, Indian Medlars Centre, African Index Medicus, and reference lists were searched for randomized controlled trials (RCTs) or quasi-RCTs. 22 trials (n = 101 507) met the selection criteria.
Meta-analysis showed that pneumococcal vaccination did not differ from control for definitive pneumococcal pneumonia (Table). The pneumococcal vaccination group had fewer cases of presumptive pneumococcal pneumonia and all-cause pneumonia than the control group, but meta-analysis of double-blind RCTs showed no difference between groups (Table). Groups did not differ for bacteremia (Table), bronchitis, or mortality.
Pneumococcal vaccination is not effective for preventing pneumonia, bacteremia, bronchitis, or mortality in adults.
Pneumococcal vaccination vs placebo, other vaccination, or no intervention (control) in adults*
*PP = pneumococcal pneumonia; RCT = randomized controlled trial; other abbreviations defined in Glossary. Weighted event rates, NNT, NNH, and CI calculated from control event rates provided by author and relative risks in article using a random-effect model.
†Information provided by author.
Johnstone J. Review: Pneumococcal vaccination is not effective for preventing pneumonia, bacteremia, bronchitis, or mortality. Ann Intern Med. 2009;150:JC5–4. doi: 10.7326/0003-4819-150-10-200905190-02004
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Published: Ann Intern Med. 2009;150(10):JC5-4.
Infectious Disease, Multi-Organ Failure and Sepsis, Pneumonia, Prevention/Screening, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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