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Does 23PPV Really Work?

Previous immunization with the 23-valent polysaccharide pneumococcal vaccine was associated with a 50% reduction in mortality in adults with community-acquired pneumonia.

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP); serious infections with this organism have a case-fatality rate of 10% to 40% in older individuals. The 23-valent polysaccharide pneumococcal vaccine (23PPV) is currently recommended for adults aged 65 and for younger individuals with long-term health problems or impaired immunity. Although observational studies have suggested that the vaccine reduces risk for invasive pneumococcal disease, clear-cut evidence that it reduces mortality in older adults is limited. Now, using a database containing records from 109 U.S. hospitals, researchers have assessed outcomes among adult CAP inpatients in relation to their pneumococcal vaccination status.

Of 62,918 patients hospitalized between 1999 and 2003, 12% had documented vaccination, 23% were documented to be unvaccinated, and the rest were of unknown vaccine status. After adjustment for confounding variables such as comorbidities, age, and receipt of influenza immunization, the odds ratio for mortality among patients with documented vaccination was 0.50 (95% confidence interval, 0.43–0.59) compared to those without documented vaccination. The effect of vaccination on reducing mortality was similar between patients 65 years old and those <65, but was significantly greater during the first 72 hours of hospital admission than thereafter (P< 0.001).

Comment: The effectiveness of 23PPV continues to generate debate. A problem with the current study is that vaccination might have been a marker for overall better medical care or general health. Nevertheless, these data bolster the argument that 23PPV is effective. Given the very low rate of documented vaccination, efforts to increase this rate are certainly in order.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases May 5, 2006

Citation(s):

Fisman DN et al. Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia. Clin Infect Dis 2006 Apr 15; 42:1093-101.

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• Medline abstract (Free)

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