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 languageEnglish
Article numbere0171943
JournalPLoS ONE
Volume12
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

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