Efficacy of Pneumococcal Vaccines for Preventing Pneumonia in COPD
COPD exacerbation likely reduced with vaccination, and moderate-quality evidence suggests the benefits of pneumococcal vaccination in COPD patients.
A Cochrane review found that polyvalent pneumococcal vaccines offered significant protection against community-acquired pneumonia (CAP) in chronic obstructive pulmonary disease (COPD) patients, however, the evidence did not show that vaccination lowered the risk of confirmed pneumococcal pneumonia.
Patients with COPD have a higher risk of pneumococcal disease (eg, pneumonia) and acute exacerbations with associated morbidity and healthcare costs. Study authors aimed to determine the efficacy of injectable pneumococcal vaccines for preventing pneumonia in COPD patients.
Randomized controlled trials that compared injectable pneumococcal polysaccharide vaccine (PPV) or pneumococcal conjugated vaccine (PCV) vs a control or alternative vaccine type in patients with COPD were included for the review. Five studies (n = 606) were added for this update, bringing the review's total to 12 trials involving 2171 patients with COPD.
The vaccination group was found to have a lower risk for developing CAP vs the control group (odds ratio [OR] 0.62, 95% CI: 0.43 to 0.89; GRADE: moderate). These findings did not differ specifically for pneumococcal pneumonia (OR 0.26, 95% CI: 0.05 to 1.31; GRADE: low).
Between vaccine and control groups, death from cardiorespiratory causes (OR 1.07, 95% CI: 0.69 to 1.66; GRADE: moderate) and all-cause mortality (OR 1.00, 95% CI: 0.72 to 1.40; GRADE: moderate) did not differ. Further, the risk of hospitalization for any cause, or for cardiorespiratory causes, did not differ between vaccine and control groups.
Vaccination was found to significantly decrease the risk of a COPD exacerbation (OR 0.60, 95% CI: 0.39 to 0.93; GRADE: moderate). One study that compared the efficacy of the 23-valent PPV vs 7-valent PCV reported no differences for CAP, all-cause mortality, hospital admission or risk of a COPD exacerbation. However, a greater chance of some mild adverse effects were reported with the PPV-23 vaccine.
Although moderate-quality evidence pointed to the benefits of pneumococcal vaccination in patients with COPD, "evidence was insufficient for comparison of different pneumococcal vaccine types," added author Julia AE Walters.
Walters JA, Tang JN, Poole P, Wood-Baker R. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease [published online January 24, 2017]. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD001390.pub4