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Meta-Analysis
. 2016 Mar 4;113(9):139-46.
doi: 10.3238/arztebl.2016.0139.

The Clinical Effectiveness of Pneumococcal Conjugate Vaccines: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Hannah Ewald  1 , Matthias Briel, Danielle Vuichard, Veronika Kreutle, Andriy Zhydkov, Viktoria Gloy
Affiliations
Meta-Analysis

The Clinical Effectiveness of Pneumococcal Conjugate Vaccines: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Hannah Ewald et al. Dtsch Arztebl Int. .

Abstract

Background: Streptococcus pneumoniae is responsible for approximately 1.6 million yearly deaths worldwide. An up-to-date evidence base on the effects of pneumococcal conjugate vaccines (PCVs) on infectious diseases and mortality in any population or setting regardless of age or health status is currently lacking.

Methods: We systematically searched MEDLINE and EMBASE for pertinent randomized controlled trials (RCTs). Two reviewers independently screened 9498 titles/abstracts and 430 full-text papers for eligible trials. The outcomes of our meta-analysis were pooled using relative risks (RRs) with a random effects model or Peto's odds ratios (ORs) if event rates were :lt;1%.

Results: 21 RCTs comprising 361 612 individuals were included. PCVs reduced the risk for invasive pneumococcal disease (odds ratio [OR]: 0.43, 95% confidence interval [CI]: [0.36; 0.51]), all-cause acute otitis media (AOM) (RR: 0.93, 95% CI: [0.86; 1.00]), pneumococcal AOM (RR: 0.57, 95% CI: [0.39; 0.83]), allcause pneumonia (RR: 0.93, 95% CI: [0.89; 0.97]), and pneumococcal pneumonia (RR: 0.78, 95% CI: [0.62; 0.97]). We found no significant effect of PCVs on all-cause mortality (RR: 0.95, 95% CI: [0.88; 1.03]) or recurrent AOM (RR: 0.87, 95% CI: [0.72; 1.05]).

Conclusion: PCVs are associated with large risk reductions for pneumococcal infectious diseases, smaller risk reductions for infectious diseases from any cause, and no significant effect on all-cause mortality.

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Figures

Figure 1
Figure 1
Effect of pneumococcal conjugate vaccines versus control on all-cause mortality, stratified by vaccine type, Control comprises placebo, no intervention, 23-valent pneumococcal polysaccharide vaccine, and non-pneumococcal vaccines. PCV, pneumococcal conjugate vaccine; CI, confidence interval. Full references for these studies can be found in eSupplement 2
Figure 2
Figure 2
Effect of pneumococcal conjugate vaccine versus control on invasive pneumococcal disease, stratified by vaccine type. Control comprises placebo, no intervention, 23-valent pneumococcal polysaccharide vaccine, and non-pneumococcal vaccines OR, odds ratio; CI, confidence interval Full references for these studies can be found in eSupplement 2
Figure 3
Figure 3
Effect of pneumococcal conjugate vaccine versus control on pneumonia stratified by vaccine type. Control comprises placebo, no intervention, 23-valent pneumococcal polysaccharide vaccine, and non-pneumococcal vaccines Full references for these studies can be found in eSupplement 2
eFigure 1
eFigure 1
Study selection process
eFigure 2
eFigure 2
Risk of bias assessment: review authors’ judgments for each included study Green circle with plus sign: low risk of bias; yellow circle with question mark: unclear risk of bias; red circle with minus sign: high risk
See this image and copyright information in PMC

Comment in

References

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