Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults
Lisa A. Jackson, M.D., M.P.H., Kathleen M. Neuzil, M.D., M.P.H., Onchee Yu, M.S., Patti Benson, M.P.H., William E. Barlow, Ph.D., Annette L. Adams, M.P.H., Christi A. Hanson, B.A., Lisa D. Mahoney, M.P.H., David K. Shay, M.D., M.P.H., William W. Thompson, Ph.D., for the Vaccine Safety Datalink
BackgroundStreptococcus pneumoniae is the chief cause of pneumoniain older adults, but it remains unclear whether use of the pneumococcalpolysaccharide vaccine alters the overall risk of community-acquiredpneumonia. In a large population of older adults, we assessedthe effectiveness of the pneumococcal vaccine.
Methods In this retrospective cohort study, 47,365 Group HealthCooperative members 65 years of age or older were assessed overa three-year period. The primary outcomes were hospitalizationbecause of community-acquired pneumonia (validated by chartreview), pneumonia in patients who were not hospitalized ("outpatientpneumonia," determined from administrative data sources), andpneumococcal bacteremia. The association between pneumococcalvaccination and the risk of each outcome was evaluated by meansof multivariate Cox proportional-hazards models, with adjustmentfor age, sex, nursing-home residence or nonresidence, smokingstatus, medical conditions, and receipt or nonreceipt of influenzavaccine.
Results During the study period, 1428 cohort members were hospitalizedwith community-acquired pneumonia, 3061 were assigned a diagnosisof outpatient pneumonia, and 61 had pneumococcal bacteremia.Receipt of the pneumococcal vaccine was associated with a significantreduction in the risk of pneumococcal bacteremia (hazard ratio,0.56; 95 percent confidence interval, 0.33 to 0.93) but a slightlyincreased risk of hospitalization for pneumonia (hazard ratio,1.14; 95 percent confidence interval, 1.02 to 1.28). Pneumococcalvaccination did not alter the risk of outpatient pneumonia (hazardratio, 1.04; 95 percent confidence interval, 0.96 to 1.13) orof any case of community-acquired pneumonia, whether or notit required hospitalization (hazard ratio, 1.07; 95 percentconfidence interval, 0.99 to 1.14).
Conclusions These findings support the effectiveness of thepneumococcal polysaccharide vaccine for the prevention of bacteremia,but they suggest that alternative strategies are needed to preventnonbacteremic pneumonia, which is a more common manifestationof pneumococcal infection in elderly persons.
Source Information
From the Center for Health Studies, Group Health Cooperative, Seattle (L.A.J., O.Y., P.B., W.E.B., A.L.A., C.A.H., L.D.M.); the Departments of Epidemiology (L.A.J., A.L.A.), Medicine (K.M.N.), and Biostatistics (W.E.B.), University of Washington, Seattle; the Veterans Affairs Puget Sound Health Care System, Seattle (K.M.N.); and the National Immunization Program, Centers for Disease Control and Prevention, Atlanta (D.K.S., W.W.T.).
Address reprint requests to Dr. Jackson at the Center for Health Studies, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, or at jackson.l{at}ghc.org.
Pneumococcal Vaccination in Older Adults
Hirschmann J. V., Hak E., Bonten M. J.M., Hoes A. W., Marras T. K., Fedson D. S., Jackson L. A., Neuzil K. M., Thompson W. W.
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N Engl J Med 2003;
349:712-714, Aug 14, 2003.
Correspondence
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