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Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents...

in
Publisher: 
BMJ
Date published: 
9 March, 2010
Author: 
Takaya Maruyama, resident physician and researcher1, Osamu Taguchi, associate professor and vice chairman1, Michael S Niederman, professor of medicine and chairman6, John Morser, senior research scientist5, Hiroyasu Kobayashi, assistant professor and chief resident1, Tetsu Kobayashi, assistant professor1, Corina D’Alessandro-Gabazza, research assistant1, Sei Nakayama, resident physician4, Kimiaki Nishikubo, resident physician4, Takashi Noguchi, director4, Yoshiyuki Takei, professor and chairman2, Esteban C Gabazza, professor and chairman3
Region: 
International

Publication type: 
research
Featured item on home page: 
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Publication link: 
Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial

1 Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Japan, 2 Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan, 3 Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan, 4 Kinan General Hospital, Minamimuro, Mie, Japan, 5 Division of Hematology, Stanford School of Medicine, Stanford, CA, USA, 6 Department of Medicine, Winthrop University Hospital, Mineola, NY, USA

Correspondence to: E C Gabazza gabazza@doc.medic.mie-u.ac.jp

Objective

To determine the efficacy of a 23-valent pneumococcal

polysaccharide vaccine in people at high risk of pneumococcal

pneumonia.

Design Prospective, randomised, placebo controlled double blind study.

Setting Nursing homes in Japan.

Participants 1006 nursing home residents.

Interventions Participants were randomly allocated to either 23-valent pneumococcal polysaccharide vaccine (n=502) or placebo (n=504).

Main outcome measures The primary end points were the incidence of all cause pneumonia and pneumococcal pneumonia. Secondary end points were deaths from pneumococcal pneumonia, all cause pneumonia, and other causes.

Results Pneumonia occurred in 63 (12.5%) participants in the vaccine group and 104 (20.6%) in the placebo group. Pneumococcal pneumonia was diagnosed in 14 (2.8%) participants in the vaccine group and 37 (7.3%) in the placebo group (P<0.001). All cause pneumonia and pneumococcal pneumonia were significantly more frequent in the placebo group than in the vaccine group: incidence per 1000 person years 55 v 91 (P<0.0006) and 12 v 32 (P<0.001), respectively. Death from pneumococcal pneumonia was significantly higher in the placebo group than in the vaccine group (35.1% (13/37) v 0% (0/14), P<0.01). The death rate from all cause pneumonia (vaccine group 20.6% (13/63) v placebo group 25.0% (26/104), P=0.5) and from other causes (vaccine group 17.7% (89/502) v placebo group (80/504) 15.9%, P=0.4) did not differ between the two study groups.

Conclusion The 23-valent pneumococcal polysaccharide vaccine prevented pneumococcal pneumonia and reduced mortality from pneumococcal pneumonia in nursing home residents.

 

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