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Inoue S, Watanuki Y, Kaneko T, et al. Heterogeneity of the efficacy of the 23-valent pneumococcal polysaccharide vaccine caused by various underlying conditions of chronic pulmonary disease in older patients: prospective cohort study. BMJ Open. 2011;1(1):e000105doi: 10.1136/bmjopen-2011-000105.
Inoue, S., Watanuki, Y., Kaneko, T., Sato, T., Miyazawa, N., Kaneko, T., Ishigatsubo, Y., Morita, S., Natsumeda, Y., & Mizushima, S. (2011). Heterogeneity of the efficacy of the 23-valent pneumococcal polysaccharide vaccine caused by various underlying conditions of chronic pulmonary disease in older patients: prospective cohort study. BMJ open, 1(1), e000105. https://doi.org/10.1136/bmjopen-2011-000105
Inoue, Satoshi, et al. "Heterogeneity of the efficacy of the 23-valent pneumococcal polysaccharide vaccine caused by various underlying conditions of chronic pulmonary disease in older patients: prospective cohort study." BMJ open vol. 1,1 (2011): e000105. doi: https://doi.org/10.1136/bmjopen-2011-000105
Inoue S, Watanuki Y, Kaneko T, Sato T, Miyazawa N, Kaneko T, Ishigatsubo Y, Morita S, Natsumeda Y, Mizushima S. Heterogeneity of the efficacy of the 23-valent pneumococcal polysaccharide vaccine caused by various underlying conditions of chronic pulmonary disease in older patients: prospective cohort study. BMJ Open. 2011 Jul 18;1(1):e000105. doi: 10.1136/bmjopen-2011-000105. PMID: 22021764; PMCID: PMC3191416.
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BMJ Open. 2011 Jul 18;1(1):e000105. doi: 10.1136/bmjopen-2011-000105.

Heterogeneity of the efficacy of the 23-valent pneumococcal polysaccharide vaccine caused by various underlying conditions of chronic pulmonary disease in older patients: prospective cohort study.

BMJ open

Satoshi Inoue, Yuji Watanuki, Tetsuji Kaneko, Takashi Sato, Naoki Miyazawa, Takeshi Kaneko, Yoshiaki Ishigatsubo, Satoshi Morita, Yutaka Natsumeda, Shunsaku Mizushima

Affiliations

  1. Department of Epidemiology and Public Health and Department of Clinical Research, Yokohama City University Graduate School of Medicine, Yokohama, Japan. [email protected]

PMID: 22021764 PMCID: PMC3191416 DOI: 10.1136/bmjopen-2011-000105

Abstract

OBJECTIVE: To determine the ideal conditions for use of the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older outpatients with chronic pulmonary diseases.

DESIGN: Prospective cohort study.

PARTICIPANTS: 1378 outpatients with chronic pulmonary diseases ≥ 60 years of age.

INTERVENTION: Participants were educated about PPV23, and those who responded affirmatively were vaccinated between August and November 2002. The participants who chose no intervention served as controls. The prevaccine period was defined as August 2001 to August 2002. Participants were followed for 2 years from December 2002 or until death.

MAIN OUTCOME MEASURES: Events of interest included the first episode of bacterial (including pneumococcal) pulmonary infection (primary endpoint) and death of any cause (secondary endpoint).

RESULTS: Frequent episodes of pulmonary infection during the prevaccine period significantly decreased event-free survival during the 2-year observation period (p<0.001). Chronic respiratory failure was associated with a decreased event-free survival only when the pulmonary infection episode did not occur in the prevaccine period (p<0.001). No significant differences in event-free survival were observed between the vaccinated and unvaccinated group during analysis of the entire cohort. In the Cox proportional hazards regression model, event-free survival decreased significantly when pulmonary infection occurred in the prevaccine period. In the subgroup analysis, the first episode of bacterial pulmonary infection (but not death of any cause) was reduced significantly by PPV23 only in patients with chronic respiratory failure who had no episodes of pulmonary infection during the prevaccine period (p=0.019).

CONCLUSION: The efficacy of PPV23 against pulmonary infection and death of any cause might be unachievable if pulmonary infection occurs during the prevaccine period. PPV23 needs to be given to older patients with chronic pulmonary disease at an earlier time in which infectious complications in the lung have not yet occurred.

References

  1. Arch Intern Med. 1994 Dec 12-26;154(23):2666-77 - PubMed
  2. Chest. 1987 Aug;92(2):204-12 - PubMed
  3. J Gen Intern Med. 2007 Jan;22(1):62-7 - PubMed
  4. MMWR Morb Mortal Wkly Rep. 2010 Sep 3;59(34):1102-6 - PubMed
  5. Curr Opin Pulm Med. 2003 May;9(3):175-80 - PubMed
  6. BMJ. 2010 Mar 08;340:c1004 - PubMed
  7. MMWR Recomm Rep. 1997 Apr 4;46(RR-8):1-24 - PubMed
  8. Arch Intern Med. 1999 Nov 8;159(20):2437-42 - PubMed
  9. CMAJ. 2009 Jan 6;180(1):18-9 - PubMed
  10. CMAJ. 1987 Feb 15;136(4):361-5 - PubMed
  11. J Infect. 2009 Jun;58(6):417-24 - PubMed
  12. N Engl J Med. 2009 Jan 15;360(3):244-56 - PubMed
  13. Wkly Epidemiol Rec. 2008 Oct 17;83(42):373-84 - PubMed
  14. West J Med. 1982 Jan;136(1):1-5 - PubMed
  15. BMC Fam Pract. 2000;1:1 - PubMed
  16. Thorax. 2006 Mar;61(3):189-95 - PubMed
  17. N Engl J Med. 1997 Jan 23;336(4):243-50 - PubMed
  18. Vaccine. 2008 Mar 10;26(11):1420-31 - PubMed
  19. HIV Med. 2011 Jul;12(6):323-33 - PubMed
  20. Respir Med. 2010 Mar;104(3):397-403 - PubMed
  21. Lancet. 2009 Aug 29;374(9691):668-70 - PubMed
  22. Lancet. 1998 Feb 7;351(9100):399-403 - PubMed
  23. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000422 - PubMed
  24. JAMA. 2005 Oct 26;294(16):2043-51 - PubMed
  25. Eur Respir J. 2008 Jun;31(6):1274-84 - PubMed
  26. Evid Based Med. 2009 Jun;14(3):74 - PubMed
  27. N Engl J Med. 2006 Apr 6;354(14):1522-4 - PubMed
  28. N Engl J Med. 2003 May 1;348(18):1747-55 - PubMed
  29. CMAJ. 2009 Jan 6;180(1):48-58 - PubMed
  30. Ann Intern Med. 1986 Jan;104(1):106-9 - PubMed
  31. BMC Infect Dis. 2010 Mar 18;10:73 - PubMed
  32. Chest. 1999 Nov;116(5):1278-81 - PubMed
  33. Eur Respir J. 1997 May;10(5):1137-44 - PubMed

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