• Online Features  This Article  • 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 (41)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Infectious Diseases, Other  • Public Health  • Immunization  • Pneumonia  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Jennie Johnstone, MD; Thomas J. Marrie, MD; Dean T. Eurich, MSc; Sumit R. Majumdar, MD, MPH

Arch Intern Med. 2007;167(18):1938-1943.

Background  Although 23-valent polysaccharide pneumococcal vaccine (PPV) does not prevent community-acquired pneumonia (CAP), it might still improve outcomes in those who develop pneumonia. We tested this hypothesis using a population-based cohort of hospitalized patients with CAP.

Methods  From 2000 to 2002, we prospectively collected data on all adults with CAP admitted to 6 hospitals in Capital Health, the largest integrated health delivery system in Canada. Polysaccharide pneumococcal vaccine status was ascertained by interview, medical record review, and contact with physicians and community health offices. The primary outcome was the composite of in-hospital mortality or intensive care unit (ICU) admission. Multivariable regression was used to determine the independent association between PPV use and outcomes, after adjusting for patient characteristics, pneumonia severity, and propensity scores.

Results  Of the 3415 patients with CAP (median age, 75 years), 46% were female, 62% had severe pneumonia, and 22% had prior PPV. Overall, 624 patients died or were admitted to an ICU. Polysaccharide pneumococcal vaccine was protective from reaching this composite end point (73/760 [10%] vs 551/2655 [21%] for unvaccinated patients; P < .001), mostly a result of reduced ICU admission (2/760 [<1%] vs 349/2655 [13%]). The propensity-adjusted odds of death or ICU admission was 0.62 (95% confidence interval, 0.42-0.92; P = .02) for patients who had received PPV. Only 215 of 2416 patients (9%) eligible for PPV at hospital discharge were vaccinated.

Conclusions  Patients with CAP who had prior PPV had about a 40% lower rate of mortality or ICU admission compared with those who were not vaccinated. This provides additional support for recommending PPV to those at risk of pneumonia.

Author Affiliations: Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

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

RELATED LETTER

Pneumococcal Vaccination in Adults
Harunor Rashid, Shuja Shafi, Elizabeth Haworth, and Robert Booy
Arch Intern Med. 2008;168(6):666-667.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease
Viasus et al.
Nephrol Dial Transplant 2011;26:2899-2906.
ABSTRACT | FULL TEXT  

The association of pneumococcal vaccination with hospitalization and mortality in hemodialysis patients
Gilbertson et al.
Nephrol Dial Transplant 2011;26:2934-2939.
ABSTRACT | FULL TEXT  

Pneumococcal antibody levels after pneumovax in patients with rheumatoid arthritis on methotrexate
Coulson et al.
Ann Rheum Dis 2011;70:1289-1291.
ABSTRACT | FULL TEXT  

The Potential Role for Protein-Conjugate Pneumococcal Vaccine in Adults: What Is the Supporting Evidence?
Musher et al.
Clinical Infectious Diseases 2011;52:633-640.
ABSTRACT | FULL TEXT  

Factors associated with inflammatory cytokine patterns in community-acquired pneumonia
Martinez et al.
Eur Respir J 2011;37:393-399.
ABSTRACT | FULL TEXT  

Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically Ill: A Prospective Observational Study
Sligl et al.
Chest 2011;139:88-94.
ABSTRACT | FULL TEXT  

Effectiveness of the pneumococcal polysaccharide vaccine in preventing pneumonia in the elderly
Dominguez et al.
Eur Respir J 2010;36:608-614.
ABSTRACT | FULL TEXT  

Determining the Optimal Pneumococcal Vaccination Strategy for Adults: Is There a Role for the Pneumococcal Conjugate Vaccine?
Metersky et al.
Chest 2010;138:486-490.
ABSTRACT | FULL TEXT  

Impact of the Pneumococcal Vaccine on Long-Term Morbidity and Mortality of Adults at High Risk for Pneumonia
Johnstone et al.
Clinical Infectious Diseases 2010;51:15-22.
ABSTRACT | FULL TEXT  

Preventing Myocardial Infarction With Vaccination: Myths and Realities
Madjid and Musher
JAMA 2010;303:1751-1752.
FULL TEXT  

Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial
Maruyama et al.
BMJ 2010;340:c1004-c1004.
ABSTRACT | FULL TEXT  

Safety and Antibody Response, Including Antibody Persistence for 5 Years, after Primary Vaccination or Revaccination with Pneumococcal Polysaccharide Vaccine in Middle-Aged and Older Adults
Musher et al.
The Journal of Infectious Disease 2010;201:516-524.
ABSTRACT | FULL TEXT  

Revaccination with a 23-Valent Pneumococcal Polysaccharide Vaccine Induces Elevated and Persistent Functional Antibody Responses in Adults Aged >=65 Years
Manoff et al.
The Journal of Infectious Disease 2010;201:525-533.
ABSTRACT | FULL TEXT  

Guidelines and quality for community-acquired pneumonia: Measures from the Joint Commission and the Centers for Medicare and Medicaid Services
Shorr and Owens
Am J Health Syst Pharm 2009;66:S2-S7.
ABSTRACT | FULL TEXT  

Improving the simple, complicated and complex realities of community-acquired pneumonia
Liu et al.
BMJQS 2009;18:93-98.
ABSTRACT | FULL TEXT  

Historical and Regulatory Perspectives on the Treatment Effect of Antibacterial Drugs for Community-Acquired Pneumonia
Singer et al.
Clinical Infectious Diseases 2008;47:S216-S224.
ABSTRACT | FULL TEXT  

Mortality Reduction with Influenza Vaccine in Patients with Pneumonia Outside "Flu" Season: Pleiotropic Benefits or Residual Confounding?
Eurich et al.
Am. J. Respir. Crit. Care Med. 2008;178:527-533.
ABSTRACT | FULL TEXT  

Pneumococcal Vaccination in Adults
Rashid et al.
Arch Intern Med 2008;168:666-667.
FULL TEXT