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Meta-Analysis
. 2017 Jan 24;1(1):CD001390.
doi: 10.1002/14651858.CD001390.pub4.

Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease

Julia Ae Walters  1 , Joanne Ngie Qing Tang  2 , Phillippa Poole  3 , Richard Wood-Baker  2
Affiliations
Meta-Analysis

Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease

Julia Ae Walters et al. Cochrane Database Syst Rev. .

Abstract

Background: People with chronic obstructive pulmonary disease (COPD) are at increased risk of pneumococcal disease, especially pneumonia, as well as acute exacerbations with associated morbidity and healthcare costs.

Objectives: To determine the efficacy of injectable pneumococcal vaccination for preventing pneumonia in persons with COPD.

Search methods: We searched the Cochrane Airways COPD Trials Register and the databases CENTRAL, MEDLINE and Embase, using prespecified terms. Searches are current to November 2016.

Selection criteria: We included randomised controlled trials (RCT) comparing injectable pneumococcal polysaccharide vaccine (PPV) or pneumococcal conjugated vaccine (PCV) versus a control or alternative vaccine type in people with COPD.

Data collection and analysis: We used standard Cochrane methodological procedures. For meta-analyses, we subgrouped studies by vaccine type.

Main results: For this update, we added five studies (606 participants), meaning that the review now includes a total of 12 RCTs involving 2171 participants with COPD. Average age of participants was 66 years, male participants accounted for 67% and mean forced expiratory volume in one second (FEV1) was 1.2 L (five studies), 54% predicted (four studies). We assessed risks of selection, attrition and reporting bias as low, and risks of performance and detection bias as moderate.Compared with control, the vaccine group had a lower likelihood of developing community-acquired pneumonia (CAP) (odds ratio (OR) 0.62, 95% confidence interval (CI) 0.43 to 0.89; six studies, n = 1372; GRADE: moderate), but findings did not differ specifically for pneumococcal pneumonia (Peto OR 0.26, 95% CI 0.05 to 1.31; three studies, n = 1158; GRADE: low). The number needed to treat for an additional beneficial outcome (NNTB) (preventing one episode of CAP) was 21 (95% CI 15 to 74). Mortality from cardiorespiratory causes did not differ between vaccine and control groups (OR 1.07, 95% CI 0.69 to 1.66; three studies, n = 888; GRADE: moderate), nor did all-cause mortality differ (OR 1.00, 95% CI 0.72 to 1.40; five studies, n = 1053; GRADE: moderate). The likelihood of hospital admission for any cause, or for cardiorespiratory causes, did not differ between vaccine and control groups. Vaccination significantly reduced the likelihood of a COPD exacerbation (OR 0.60, 95% CI 0.39 to 0.93; four studies, n = 446; GRADE: moderate). The NNTB to prevent a patient from experiencing an acute exacerbation was 8 (95% CI 5 to 58). Only one study (n = 181) compared the efficacy of different vaccine types - 23-valent PPV versus 7-valent PCV - and reported no differences for CAP, all-cause mortality, hospital admission or likelihood of a COPD exacerbation, but investigators described a greater likelihood of some mild adverse effects of vaccination with PPV-23.

Authors' conclusions: Injectable polyvalent pneumococcal vaccination provides significant protection against community-acquired pneumonia, although no evidence indicates that vaccination reduced the risk of confirmed pneumococcal pneumonia, which was a relatively rare event. Vaccination reduced the likelihood of a COPD exacerbation, and moderate-quality evidence suggests the benefits of pneumococcal vaccination in people with COPD. Evidence was insufficient for comparison of different pneumococcal vaccine types.

PubMed Disclaimer

Conflict of interest statement

Julia Walters: none known.

Joanne Tang: none known. Co‐recipient of the Cochrane Airways Australia Satellite Scholarship that required a completion/update and presentation of a Cochrane Review.

Phillippa Poole: none known.

Richard Wood‐Baker: none known.

Figures

1
1
In the control group, 608 out of 1000 people had one or more exacerbations over 6 to 24 months, compared with 482 (95% CI 377 to 591) out of 1000 for the active treatment group.
2
2
Study flow diagram.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
5
5
Forest plot of comparison: 1 Pneumococcal vaccine versus control, outcome: 1.1 Community‐acquired pneumonia: at least 1 episode.
6
6
Forest plot of comparison: 1 Pneumococcal vaccine versus control, outcome: 1.4 Death from cardiorespiratory causes.
7
7
Forest plot of comparison: 1 Pneumococcal vaccine versus control, outcome: 1.1 At least 1 COPD exacerbation.
1.1
1.1. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 1 Community‐acquired pneumonia: at least 1 episode.
1.2
1.2. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 2 Community‐acquired pneumonia: rate per person‐year.
1.3
1.3. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 3 Pneumococcal pneumonia: at least 1 episode.
1.4
1.4. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 4 Death from cardiorespiratory causes.
1.5
1.5. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 5 Death from all causes.
1.6
1.6. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 6 Hospital admission, any cause: at least 1 episode.
1.7
1.7. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 7 Hospital admission: cardiorespiratory‐related.
1.8
1.8. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 8 Hospital admission: all‐cause.
1.9
1.9. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 9 ED visit, any cause: at least 1 episode.
1.10
1.10. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 10 At least 1 COPD exacerbation.
1.11
1.11. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 11 COPD exacerbation rate.
1.12
1.12. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 12 COPD exacerbations: rate/person‐year.
1.13
1.13. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 13 Lung function: FEV1 (L).
1.14
1.14. Analysis
Comparison 1 Pneumococcal vaccine versus control, Outcome 14 Quality of life: SGRQ overall.
2.1
2.1. Analysis
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 1 Community‐acquired pneumonia: at least 1 episode.
2.2
2.2. Analysis
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 2 Death from all causes.
2.3
2.3. Analysis
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 3 Hospital admission, any cause: at least 1 episode.
2.4
2.4. Analysis
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 4 Acute exacerbation COPD.
2.5
2.5. Analysis
Comparison 2 Comparison PPV‐23 versus PCV‐7, Outcome 5 Adverse effects.
3.1
3.1. Analysis
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 1 Pneumonia by lung function at baseline.
3.2
3.2. Analysis
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 2 Hospital admission, any cause: by follow‐up periods.
3.3
3.3. Analysis
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 3 Hospital admission, cardiorespiratory‐related: by follow‐up periods.
3.4
3.4. Analysis
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 4 Emergency department visit, any cause: by follow‐up period.
3.5
3.5. Analysis
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 5 Emergency visits (by cause).
3.6
3.6. Analysis
Comparison 3 Analysis by follow‐up period/subgroup, Outcome 6 At least 1 COPD exacerbation: varying follow‐up.
See this image and copyright information in PMC

Update of

Comment in

References

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