Effectiveness of pneumococcal polysaccharide vaccine in older adults - PubMed (original) (raw)
. 2003 May 1;348(18):1747-55.
doi: 10.1056/NEJMoa022678.
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- PMID: 12724480
- DOI: 10.1056/NEJMoa022678
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Effectiveness of pneumococcal polysaccharide vaccine in older adults
Lisa A Jackson et al. N Engl J Med. 2003.
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Abstract
Background: Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of community-acquired pneumonia. In a large population of older adults, we assessed the effectiveness of the pneumococcal vaccine.
Methods: In this retrospective cohort study, 47,365 Group Health Cooperative members 65 years of age or older were assessed over a three-year period. The primary outcomes were hospitalization because of community-acquired pneumonia (validated by chart review), pneumonia in patients who were not hospitalized ("outpatient pneumonia," determined from administrative data sources), and pneumococcal bacteremia. The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional-hazards models, with adjustment for age, sex, nursing-home residence or nonresidence, smoking status, medical conditions, and receipt or nonreceipt of influenza vaccine.
Results: During the study period, 1428 cohort members were hospitalized with community-acquired pneumonia, 3061 were assigned a diagnosis of outpatient pneumonia, and 61 had pneumococcal bacteremia. Receipt of the pneumococcal vaccine was associated with a significant reduction in the risk of pneumococcal bacteremia (hazard ratio, 0.56; 95 percent confidence interval, 0.33 to 0.93) but a slightly increased risk of hospitalization for pneumonia (hazard ratio, 1.14; 95 percent confidence interval, 1.02 to 1.28). Pneumococcal vaccination did not alter the risk of outpatient pneumonia (hazard ratio, 1.04; 95 percent confidence interval, 0.96 to 1.13) or of any case of community-acquired pneumonia, whether or not it required hospitalization (hazard ratio, 1.07; 95 percent confidence interval, 0.99 to 1.14).
Conclusions: These findings support the effectiveness of the pneumococcal polysaccharide vaccine for the prevention of bacteremia, but they suggest that alternative strategies are needed to prevent nonbacteremic pneumonia, which is a more common manifestation of pneumococcal infection in elderly persons.
Copyright 2003 Massachusetts Medical Society
Comment in
- Pneumococcal vaccination in older adults.
Hirschmann JV. Hirschmann JV. N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4. doi: 10.1056/NEJMc031314. N Engl J Med. 2003. PMID: 12917315 No abstract available. - Pneumococcal vaccination in older adults.
Hak E, Bonten MJ, Hoes AW. Hak E, et al. N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4. N Engl J Med. 2003. PMID: 12924339 No abstract available. - Pneumococcal vaccination in older adults.
Marras TK. Marras TK. N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4. N Engl J Med. 2003. PMID: 12924340 No abstract available. - Pneumococcal vaccination in older adults.
Fedson DS. Fedson DS. N Engl J Med. 2003 Aug 14;349(7):712-4; author reply 712-4. N Engl J Med. 2003. PMID: 12924341 No abstract available. - Quality of care in U.S. hospitals.
Robbins RA, Klotz SA. Robbins RA, et al. N Engl J Med. 2005 Oct 27;353(17):1860-1; author reply 1860-1. doi: 10.1056/NEJM200510273531721. N Engl J Med. 2005. PMID: 16251547 No abstract available.
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