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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Efficacy of pneumococcal vaccination in adults: A meta-analysis
CMAJ. Canadian Medical Association Journal, Volume 180, No. 1, Year 2009
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Description
Background: Clinical trials and meta-analyses have produced conflicting results of the efficacy of unconjugated pneumococcal polysaccharide vaccine in adults. We sought to evaluate the vaccine's efficacy on clinical outcomes as well as the methodologic quality of the trials. Methods: We searched several databases and all bibliographies of reviews and meta-analyses for clinical trials that compared pneumococcal polysaccharide vaccine with a control. We examined rates of pneumonia and death, taking the methodologic quality of the trials into consideration. Results: We included 22 trials involving 101 507 participants: 11 trials reported on presumptive pneumococcal pneumonia, 19 on all-cause pneumonia and 12 on all-cause mortality. The current 23-valent vaccine was used in 8 trials. The relative risk (RR) was 0.64 (95% confidence interval [CI] 0.43-0.96) for presumptive pneumococcal pneumonia and 0.73 (95% CI 0.56-0.94) for all-cause pneumonia. There was significant heterogeneity between the trials reporting on presumptive pneumonia (I2 = 74%, p < 0.001) and between those reporting on all-cause pneumonia (I2 = 90%, p < 0.001). The RR for all-cause mortality was 0.97 (95% CI 0.87-1.09), with moderate heterogeneity between trials (I2 = 44%, p = 0.053). Trial quality, especially regarding double blinding, explained a substantial proportion of the heterogeneity in the trials reporting on presumptive pneumonia and all-cause pneumonia. There was little evidence of vaccine protection in trials of higher methodologic quality (RR 1.20, 95% CI 0.75-1.92, for presumptive pneumonia; and 1.19, 95% CI 0.95-1.49, for allcause pneumonia in double-blind trials; p for heterogeneity > 0.05). The results for all-cause mortality in double-blind trials were similar to those in all trials combined. There was little evidence of vaccine protection among elderly patients or adults with chronic illness in analyses of all trials (RR 1.04, 95% CI 0.78-1.38, for presumptive pneumococcal pneumonia; 0.89, 95% CI 0.69-1.14, for all-cause pneumonia; and 1.00, 95% CI 0.87-1.14, for all-cause mortality). Interpretation: Pneumococcal vaccination does not appear to be effective in preventing pneumonia, even in populations for whom the vaccine is currently recommended. © 2009 Canadian Medical Association or its licensors.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2612051/bin/supp_180_1_48__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC2612051/bin/supp_180_1_48_v2_index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC2612051/bin/supp_180_1_48_v2_1.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC2612051/bin/supp_180_1_48_v2_2.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC2612051/bin/supp_180_1_48_v2_3.pdf
Authors & Co-Authors
Huss, Anke
Switzerland, Bern
University of Bern
Scott, Pippa
Switzerland, Bern
University of Bern
Stuck, Andreas Ernst
Switzerland, Bern
University Hospital Bern
Trotter, Caroline
United Kingdom, Bristol
University of Bristol
Egger, Matthias
Switzerland, Bern
University of Bern
United Kingdom, Bristol
University of Bristol
Statistics
Citations: 370
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1503/cmaj.080734
ISSN:
08203946
Research Areas
Disability
Genetics And Genomics
Study Approach
Systematic review