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Evidence summaries

Pneumococcal Vaccines for Patients with Chronic Obstructive Pulmonary Disease

Injectable polyvalent pneumococcal vaccination appears to be effective for reducing community-acquired pneumonia and COPD exacerbations in persons with chronic obstructive pulmonary disease compared with no vaccination. However, mortality and hospital admission are not reduced. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 12 studies with a total of 2 171 subjects. Compared with control, the vaccine group had a lower likelihood of developing community-acquired pneumonia (table T1), NNT=21 (95% CI 15 to 74), but findings did not differ specifically for pneumococcal pneumonia (very few confirmed pneumococcal pneumonias). Acute exacerbations of COPD were reduced. There was no statistically significant effect for reduction in hospital admissions, all cause mortality, or death from cardiorespiratory causes (table T1).

Pneumoccocal vaccination to prevent pneumonia in chronic obstructive pulmonary disease

OutcomeRelative effect(95% CI)Risk with controlRisk with pneumococcal vaccine (95% CI)No of participants(studies) Quality of evidence
Pneumonia, community acquired, Follow-up: 6 to 36 monthsOR 0.62(0.43 to 0.89)143 / 100094 / 1000(67 to 129)1372(6) Moderate
Death from cardiorespiratory causes,Follow-up: 24 to 48 monthsOR 1.07(0.69 to 1.66)98 / 1000104 / 1000(70 to 153)888(3) Low
Hospital admission: any cause, Follow-up: range 6 to 12 monthsOR 0.74(0.32 to 1.74)86 / 100065 / 1000(29 to 140)391(3) Moderate
COPD exacerbation, Follow-up: range 6 to 24 monthsOR 0.60 (0.39 to 0.93)608 / 1000482 / 1000(377 to 591)446(4) Moderate

Comment: The quality of evidence is downgraded imprecise results (limited study size for each comparison) and by limitations in study quality (unclear allocation concealment and blinding).

    References

    • Walters JA, Tang JN, Poole P et al. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017 (1):CD001390. [PubMed]

Primary/Secondary Keywords