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Review
. 2020 Jan;145(1):e20191200.
doi: 10.1542/peds.2019-1200. Epub 2019 Dec 16.

Asthma and the Risk of Invasive Pneumococcal Disease: A Meta-analysis

Jose A Castro-Rodriguez  1 , Katia Abarca  2 , Erick Forno  3
Affiliations
Review

Asthma and the Risk of Invasive Pneumococcal Disease: A Meta-analysis

Jose A Castro-Rodriguez et al. Pediatrics. 2020 Jan.

Abstract

Context: Invasive pneumococcal disease (IPD) and pneumonia are a leading cause of morbidity and mortality throughout the world, and asthma is the most common chronic disease of childhood.

Objective: To evaluate the risk of IPD or pneumonia among children with asthma after the introduction of pneumococcal conjugate vaccines (PCVs).

Data sources: Four electronic databases were searched.

Study selection: We selected all cohorts or case-control studies of IPD and pneumonia in populations who already received PCV (largely 7-valent pneumococcal conjugate vaccine), but not 23-valent pneumococcal polysaccharide, in which authors reported data for children with asthma and in which healthy controls were included, without language restriction.

Data extraction: Two reviewers independently reviewed all studies. Primary outcomes were occurrence of IPD and pneumonia. Secondary outcomes included mortality, hospital admissions, hospital length of stay, ICU admission, respiratory support, costs, and additional medication use.

Results: Five studies met inclusion criteria; of those, 3 retrospective cohorts (∼26 million person-years) and 1 case-control study (N = 3294 children) qualified for the meta-analysis. Children with asthma had 90% higher odds of IPD than healthy controls (odds ratio = 1.90; 95% confidence interval = 1.63-2.11; I2 = 1.7%). Pneumonia was also more frequent among children with asthma than among controls, and 1 study reported that pneumonia-associated costs increased by asthma severity.

Limitations: None of the identified studies had information of asthma therapy or compliance.

Conclusions: Despite PCV vaccination, children with asthma continue to have a higher risk of IPD than children without asthma. Further research is needed to assess the need for supplemental 23-valent pneumococcal polysaccharide vaccination in children with asthma, regardless of their use of oral steroids.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection. Two studies were reviewed but not included in the meta-analysis: Weycker et al (used data from the same cohort as Pelton et al) and Hsu et al (insufficient data available).
FIGURE 2
FIGURE 2
Meta-analysis of IPD in children with asthma compared with children without known risk factors. Please note that Pelton includes 2 different age groups (<5 years and 5–17 years), and Kwak et al included estimates for 2 years (2010 and 2011); thus, the studies have 2 separate entries in the analysis. ES, effect estimate for the OR. ID, identification.
See this image and copyright information in PMC

Comment in

References

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