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Evidence summaries

Haemophilus Influenzae Vaccination for the Prevention of Acute Exacerbations of Chronic Bronchitis

Vaccinating patients who have recurrent acute exacerbations of chronic bronchitis with oral H. influenzae vaccine in the autumn may reduce the number and severity of exacerbations over the following winter. Level of evidence: "C"

A Cochrane review [Abstract] 1 [withdrawn from the Cochrane library] included 6 studies with a total of 440 subjects with either chronic obstructive pulmonary disease (COPD) or recurrent acute exacerbations of chronic bronchitis. Oral monobacterial, whole-killed cell nontypeable Haemophilus influenzae vaccine reduced the incidence of bronchitic episodes at three months after vaccination (rate ratio is 0.69; 95% CI 0.41 to 1.14) and at six months after vaccination (rate ratio 0.82; 95% CI 0.62 to 1.09). If these results had been statistically significant, they would have represented a reduction in acute bronchitic attacks for vaccinated individuals of 31% at three months, and 18% at six. The effect had disappeared by nine months. The severity of exacerbations in the treatment group, as measured by requirement to prescribe antibiotics, was likewise reduced by 58% at three months (Peto odds ratio = 0.42; 95% CI 0.16 to 1.13), and by 65% at six months (Peto odds ratio = 0.35; 95% CI 0.16 to 0.75).

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and by inconsistency (variability in results across studies).

    References

    • Foxwell AR, Cripps AW, Dear KB. WITHDRAWN: Haemophilus influenzae oral whole cell vaccination for preventing acute exacerbations of chronic bronchitis. Cochrane Database Syst Rev 2010;(10):CD001958. [PubMed]

Primary/Secondary Keywords