Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: Results of the EVAN-65 study

A prospective cohort study evaluating the clinical effectiveness of the 23-vatent pneurnococcal. polysaccharide vaccine was conducted among 1298 Spanish older adults with chronic respiratory diseases (bronchitis, emphysema or asthma) who were followed between 2002 and 2005. Main outcomes were all-cause community-acquired pneumonia (CAP) and 30 days mortality from CAR The association between vaccination and the risk of each outcome was evaluated by multivariabte Cox proportional-hazard models adjusted for age and comorbidity pneumococcal vaccination did not alter significantly the risk of overall CAP (hazard ratio [HR]: 0.77; 95% confidence interval [Cl]: 0.56-1.07) and 30 days mortality from CAP (HR: 0.87; 95% Cl: 0.33-2.28). However, a borderline significant reduction of 30% in the risk of all-cause hospitatisation for CAP was observed among vaccinated subjects (HR: 0.70; 95% Cl: 0.48-1.00; p = 0.052). The effectiveness of the vaccine on the combined endpoint of pneumococcal and unknown organism infections reached 34% (HR: 0.66; 95% CI: 0.43-1.01; p = 0.059). Although our findings suggest moderate benefits from the vaccination, the evidence of clinical effectiveness appears limited. (c) 2008 Elsevier Ltd. All rights reserved.