You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


Advertisement

ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | RSS | Access Rights | Sign In


  Vol. 155 No. 21, 27 NOVEMBER 1995 TABLE OF CONTENTS
  Online Only
 •  Online First Table of
Contents
  Original Investigations
 •Online Features
 This Article
 •References
 •Full text PDF
 • Reply to article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (120)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Delicious Add to Digg Add to Facebook Add to Reddit Add to Technorati Add to Twitter What's this?

Preventing Pneumococcal Bacteremia in Patients at Risk

Results of a Matched Case-Control Study

Barry M. Farr, MD, MSc; B. Lynn Johnston, MD; David K. Cobb, MD; Michael J. Fisch, MD; Teresa P. Germanson, MPH, PhD; Karim A. Adal, MD, MS; Anne M. Anglim, MD, MS

Arch Intern Med. 1995;155(21):2336-2340.


Abstract



Background
Three randomized controlled trials of the effectiveness of pneumococcal vaccine in elderly and chronically ill adults in the United States have failed to show significant protective efficacy during 44 213 person-years of follow-up. Case-control studies have greater statistical power to detect significant prevention of rare diseases such as pneumococcal bacteremia, but they also have a greater susceptibility to bias, necessitating consistent results from multiple studies. Three case-control studies at two different universities have shown prevention of systemic infection, but another study found no benefit.

Methods
Patients with pneumococcal bacteremia who were at least 2 years old and had chronic illness indicating the need for pneumococcal vaccine, or who were at least 65 years old were compared with matched control subjects for frequency of prior vaccination. Matching variables included date of admission, age, sex, race, type and duration of chronic illness serving as the major vaccine indication, number of vaccine indications and number of medical hospitalizations since licensure of the pneumococcal vaccine in 1978, and type of primary medical care.

Results
Pneumococcal vaccination was documented in the records of six (7%) of 85 cases and 26 (17%) of 152 control subjects, suggesting 81% efficacy in conditional logistical regression analysis (95% confidence interval, 34% to 94%, P=008).

Conclusions
Four case-control studies at three universities have now demonstrated significant protective efficacy of pneumococcal vaccine for preventing pneumococcal bacteremia. The development of antibiotic-resistant Streptococcus pneumoniae indicates an urgent need for an increased rate of vaccination among high-risk patients and for the development of more immunogenic conjugate vaccines that may enhance efficacy among elderly and immunocompromised patients as well as infants.

(Arch Intern Med. 1995;155:2336-2340)



Author Affiliations



From the University of Virginia Health Sciences Center, Charlottesville.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Delicious Delicious   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pneumococcal Vaccination of Elderly Adults: New Paradigms for Protection
Plotkin et al.
Clinical Infectious Diseases 2008;47:1328-1338.
ABSTRACT | FULL TEXT  

Invasive Pneumococcal Disease Among White Mountain Apache Adults, 1991-2005
Bliss et al.
Arch Intern Med 2008;168:749-755.
ABSTRACT | FULL TEXT  

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults
Mandell et al.
Clinical Infectious Diseases 2007;44:S27-S72.
FULL TEXT  

Protective Effects of the 23-Valent Pneumococcal Polysaccharide Vaccine in the Elderly Population: The EVAN-65 Study
Vila-Corcoles et al.
Clinical Infectious Diseases 2006;43:860-868.
ABSTRACT | FULL TEXT  

Guidelines for the management of adult lower respiratory tract infections
Woodhead et al.
Eur Respir J 2005;26:1138-1180.
ABSTRACT | FULL TEXT  

An economic analysis of a pneumococcal vaccine programme in people aged over 64 years in a developed country setting
Mangtani et al.
Int J Epidemiol 2005;34:565-574.
ABSTRACT | FULL TEXT  

Effectiveness of Pneumococcal Vaccination for Elderly People in Catalonia, Spain: A Case-Control Study
Dominguez et al.
Clinical Infectious Diseases 2005;40:1250-1257.
ABSTRACT | FULL TEXT  

Additive preventive effect of influenza and pneumococcal vaccines in elderly persons
Christenson et al.
Eur Respir J 2004;23:363-368.
ABSTRACT | FULL TEXT  

Invasive Pneumococcal Disease among Navajo Adults, 1989-1998
Watt et al.
Clinical Infectious Diseases 2004;38:496-501.
ABSTRACT | FULL TEXT  

Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults
Mandell et al.
Clinical Infectious Diseases 2003;37:1405-1433.
FULL TEXT  

Effectiveness of the 23-Valent Polysaccharide Vaccine against Invasive Pneumococcal Disease in Navajo Adults
Benin et al.
The Journal of Infectious Disease 2003;188:81-89.
ABSTRACT | FULL TEXT  

Pneumococcal Vaccination and Revaccination of Older Adults
Artz et al.
Clin. Microbiol. Rev. 2003;16:308-318.
ABSTRACT | FULL TEXT  

Failure to Vaccinate Medicare Inpatients: A Missed Opportunity
Bratzler et al.
Arch Intern Med 2002;162:2349-2356.
ABSTRACT | FULL TEXT  

Quality Indicators for the Management of Pneumonia in Vulnerable Elders
Rhew
ANN INTERN MED 2001;135:736-743.
FULL TEXT  

Rethinking Recommendations for Use of Pneumococcal Vaccines in Adults
Gellin et al.
Clinical Infectious Diseases 2001;33:662-675.
ABSTRACT | FULL TEXT  

Pneumococcal vaccination: current and future issues
Ortqvist
Eur Respir J 2001;18:184-195.
ABSTRACT | FULL TEXT  

Evaluation of Effectiveness of the 23-Valent Pneumococcal Capsular Polysaccharide Vaccine for HIV-Infected Patients
Breiman et al.
Arch Intern Med 2000;160:2633-2638.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Pneumococcal Vaccination of Older People: A Study in 5 Western European Countries
Ament et al.
Clinical Infectious Diseases 2000;31:444-450.
ABSTRACT | FULL TEXT  

Serotype Distribution and Antimicrobial Resistance Patterns of Invasive Isolates of Streptococcus pneumoniae: Alaska, 1991-1998
Rudolph et al.
The Journal of Infectious Disease 2000;182:490-496.
ABSTRACT | FULL TEXT  

The Health and Economic Benefits Associated With Pneumococcal Vaccination of Elderly Persons With Chronic Lung Disease
Nichol et al.
Arch Intern Med 1999;159:2437-2442.
ABSTRACT | FULL TEXT  

Prognosis After Community-Acquired Pneumonia in the Elderly: A Population-Based 12-Year Follow-up Study
Koivula et al.
Arch Intern Med 1999;159:1550-1555.
ABSTRACT | FULL TEXT  

The place of pneumococcal vaccination
DTB 1998;36:73-76.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Vaccination Against Pneumococcal Bacteremia Among Elderly People
Sisk et al.
JAMA 1997;278:1333-1339.
ABSTRACT  

Adult Bacteremic Pneumococcal Pneumonia in a Community Teaching Hospital, 1992-1996n: A Detailed Analysis of 108 Cases
Watanakunakorn and Bailey
Arch Intern Med 1997;157:1965-1971.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1995 American Medical Association. All Rights Reserved.