Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

Àngela Domínguez; Núria Soldevila; Diana Toledo; Núria Torner; Luis Force; María José Pérez; Vicente Martín; Lourdes Rodríguez-Rojas; Jenaro Astray; Mikel Egurrola; Francisco Sanz; Jesús Castilla; J. M. Mayoral; J. Díaz-Borrego; A. Morillo; J. Gutiérrez; M. Pérez-Ruiz; M. A. Fernández-Sierra; S. Tamames; S. Rojo-Rello; R. Ortiz De Lejarazu; M. I. Fernández-Natal; T. Fernández-Villa; A. Pueyo; V. Martin; A. Vilella; M. Campins; A. Antón; G. Navarro; M. Riera; E. Espejo; M. D. Mas; R. Pérez; J. A. Cayla; C. Rius; P. Godoy; C. Izquierdo; R. Torra; I. Crespo; M. F. Domínguez-Berjon; M. A. Gutiérrez; S. Jiménez; E. Gil; F. Martín; R. Génova-Maleras; M. C. Prados; F. Enzzine De Blas; M. A. Salvador; J. Rodríguez; M. Romero; J. C. Galán; E. Navas; C. J. Álvarez; E. Banderas; S. Fernandez; J. Chamorro; I. Casado; J. Díaz; M. J. López De Goicoechea; M. Morales-Suárez-Varela

doi:10.1371/journal.pone.0171943

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

Àngela Domínguez, Núria Soldevila, Diana Toledo, Núria Torner, Luis Force, María José Pérez, Vicente Martín, Lourdes Rodríguez-Rojas, Jenaro Astray, Mikel Egurrola, Francisco Sanz, Jesús Castilla, J. M. Mayoral, J. Díaz-Borrego, A. Morillo, J. Gutiérrez, M. Pérez-Ruiz, M. A. Fernández-Sierra, S. Tamames, S. Rojo-RelloR. Ortiz De Lejarazu, M. I. Fernández-Natal, T. Fernández-Villa, A. Pueyo, V. Martin, A. Vilella, M. Campins, A. Antón, G. Navarro, M. Riera, E. Espejo, M. D. Mas, R. Pérez, J. A. Cayla, C. Rius, P. Godoy, C. Izquierdo, R. Torra, I. Crespo, M. F. Domínguez-Berjon, M. A. Gutiérrez, S. Jiménez, E. Gil, F. Martín, R. Génova-Maleras, M. C. Prados, F. Enzzine De Blas, M. A. Salvador, J. Rodríguez, M. Romero, J. C. Galán, E. Navas, C. J. Álvarez, E. Banderas, S. Fernandez, J. Chamorro, I. Casado, J. Díaz, M. J. López De Goicoechea, M. Morales-Suárez-Varela

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Abstract

© 2017 Domínguez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged 65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.

Original language	English
Article number	e0171943
Journal	PLoS ONE
Volume	12
Issue number	2
DOIs	https://doi.org/10.1371/journal.pone.0171943
Publication status	Published - 1 Feb 2017

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10.1371/journal.pone.0171943

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Domínguez, À., Soldevila, N., Toledo, D., Torner, N., Force, L., Pérez, M. J., Martín, V., Rodríguez-Rojas, L., Astray, J., Egurrola, M., Sanz, F., Castilla, J., Mayoral, J. M., Díaz-Borrego, J., Morillo, A., Gutiérrez, J., Pérez-Ruiz, M., Fernández-Sierra, M. A., Tamames, S., ... Morales-Suárez-Varela, M. (2017). Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain. PLoS ONE, 12(2), [e0171943]. https://doi.org/10.1371/journal.pone.0171943

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title = "Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain",

abstract = "{\textcopyright} 2017 Dom{\'i}nguez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged 65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.",

author = "{\`A}ngela Dom{\'i}nguez and N{\'u}ria Soldevila and Diana Toledo and N{\'u}ria Torner and Luis Force and P{\'e}rez, {Mar{\'i}a Jos{\'e}} and Vicente Mart{\'i}n and Lourdes Rodr{\'i}guez-Rojas and Jenaro Astray and Mikel Egurrola and Francisco Sanz and Jes{\'u}s Castilla and Mayoral, {J. M.} and J. D{\'i}az-Borrego and A. Morillo and J. Guti{\'e}rrez and M. P{\'e}rez-Ruiz and Fern{\'a}ndez-Sierra, {M. A.} and S. Tamames and S. Rojo-Rello and {Ortiz De Lejarazu}, R. and Fern{\'a}ndez-Natal, {M. I.} and T. Fern{\'a}ndez-Villa and A. Pueyo and V. Martin and A. Vilella and M. Campins and A. Ant{\'o}n and G. Navarro and M. Riera and E. Espejo and Mas, {M. D.} and R. P{\'e}rez and Cayla, {J. A.} and C. Rius and P. Godoy and C. Izquierdo and R. Torra and I. Crespo and Dom{\'i}nguez-Berjon, {M. F.} and Guti{\'e}rrez, {M. A.} and S. Jim{\'e}nez and E. Gil and F. Mart{\'i}n and R. G{\'e}nova-Maleras and Prados, {M. C.} and {Enzzine De Blas}, F. and Salvador, {M. A.} and J. Rodr{\'i}guez and M. Romero and Gal{\'a}n, {J. C.} and E. Navas and {\'A}lvarez, {C. J.} and E. Banderas and S. Fernandez and J. Chamorro and I. Casado and J. D{\'i}az and {L{\'o}pez De Goicoechea}, {M. J.} and M. Morales-Su{\'a}rez-Varela",

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Domínguez, À, Soldevila, N, Toledo, D, Torner, N, Force, L, Pérez, MJ, Martín, V, Rodríguez-Rojas, L, Astray, J, Egurrola, M, Sanz, F, Castilla, J, Mayoral, JM, Díaz-Borrego, J, Morillo, A, Gutiérrez, J, Pérez-Ruiz, M, Fernández-Sierra, MA, Tamames, S, Rojo-Rello, S, Ortiz De Lejarazu, R, Fernández-Natal, MI, Fernández-Villa, T, Pueyo, A, Martin, V, Vilella, A, Campins, M, Antón, A, Navarro, G, Riera, M, Espejo, E, Mas, MD, Pérez, R, Cayla, JA, Rius, C, Godoy, P, Izquierdo, C, Torra, R, Crespo, I, Domínguez-Berjon, MF, Gutiérrez, MA, Jiménez, S, Gil, E, Martín, F, Génova-Maleras, R, Prados, MC, Enzzine De Blas, F, Salvador, MA, Rodríguez, J, Romero, M, Galán, JC, Navas, E, Álvarez, CJ, Banderas, E, Fernandez, S, Chamorro, J, Casado, I, Díaz, J, López De Goicoechea, MJ & Morales-Suárez-Varela, M 2017, 'Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain', PLoS ONE, vol. 12, no. 2, e0171943. https://doi.org/10.1371/journal.pone.0171943

TY - JOUR

T1 - Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

AU - Domínguez, Àngela

AU - Soldevila, Núria

AU - Toledo, Diana

AU - Torner, Núria

AU - Force, Luis

AU - Pérez, María José

AU - Martín, Vicente

AU - Rodríguez-Rojas, Lourdes

AU - Astray, Jenaro

AU - Egurrola, Mikel

AU - Sanz, Francisco

AU - Castilla, Jesús

AU - Mayoral, J. M.

AU - Díaz-Borrego, J.

AU - Morillo, A.

AU - Gutiérrez, J.

AU - Pérez-Ruiz, M.

AU - Fernández-Sierra, M. A.

AU - Tamames, S.

AU - Rojo-Rello, S.

AU - Ortiz De Lejarazu, R.

AU - Fernández-Natal, M. I.

AU - Fernández-Villa, T.

AU - Pueyo, A.

AU - Martin, V.

AU - Vilella, A.

AU - Campins, M.

AU - Antón, A.

AU - Navarro, G.

AU - Riera, M.

AU - Espejo, E.

AU - Mas, M. D.

AU - Pérez, R.

AU - Cayla, J. A.

AU - Rius, C.

AU - Godoy, P.

AU - Izquierdo, C.

AU - Torra, R.

AU - Crespo, I.

AU - Domínguez-Berjon, M. F.

AU - Gutiérrez, M. A.

AU - Jiménez, S.

AU - Gil, E.

AU - Martín, F.

AU - Génova-Maleras, R.

AU - Prados, M. C.

AU - Enzzine De Blas, F.

AU - Salvador, M. A.

AU - Rodríguez, J.

AU - Romero, M.

AU - Galán, J. C.

AU - Navas, E.

AU - Álvarez, C. J.

AU - Banderas, E.

AU - Fernandez, S.

AU - Chamorro, J.

AU - Casado, I.

AU - Díaz, J.

AU - López De Goicoechea, M. J.

AU - Morales-Suárez-Varela, M.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - © 2017 Domínguez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged 65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.

AB - © 2017 Domínguez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged 65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.

U2 - 10.1371/journal.pone.0171943

DO - 10.1371/journal.pone.0171943

M3 - Article

VL - 12

IS - 2

M1 - e0171943

ER -

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

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