Prior pneumococcal vaccination does not prevent bacteremia or ICU admission in
patients hospitalized for community-acquired pneumonia due to Streptococcus
pneumoniae: Results from the CAPO international cohort study
Lauren Burke1,2, Ruth L. Carrico, PhD3, Timothy Wiemken, PhD3
University of Louisville, School of Public Health and Information Sciences1, School of Medicine2, and School of Medicine, Division of Infectious Diseases2
INTRODUCTION
• Disease due to Streptoccocus pneumoniae,
including pneumonia, is a leading cause of mortality
worldwide.1
CONCLUSIONS
RESULTS
1
2
3
• Acute respiratory infection, including pneumonia, is
the 8th leading cause of death in the United States.2
• The incidence of pneumococcal vaccination
during hospital admission was 15% overall, and
ranged from 8% to 17% (Europe > Latin
America > North America > Africa and Asia).
• The frequency of pneumococcal vaccination
prior to hospitalization was 17% overall, and
ranged from 15% to 29% (Africa and Asia >
North America > Europe > Latin America).
• Pneumonia due to S. pneumoniae is considered a
vaccine preventable disease, there is debate
regarding the effectiveness of the vaccine.3
Previous studies show inconsistent results
regarding disease prevention and improved clinical
outcomes.2-9
1: USA and Canada
• These results indicate there is room for
improvement in vaccine compliance according
to recommended care guidelines for CAP.
2: Spain, Italy, Germany, Greece, Andorra, Portugal, Scotland,
Switzerland, The Netherlands
3: Argentina, Brazil, Chile, Guatemala, Honduras, Panama, Paraguay,
Peru, Puerto Rico, Uruguay, Venezuala
4: Australia, India, Israel, Lebanon, The Phillipines, China,
South Africa
• The Community Acquired Pneumonia Organization
(CAPO) international cohort study has collected
information regarding pneumococcal pneumonia
prevention and management since 2001.10
Figure 1: Illustration of the four regions included in the CAPO international cohort study and a list of countries within each
region11
Figure 2: Vaccine incidence related to frequency of polysaccharide pneumococcal vaccination after hospitalization for CAP by
region and overall.
• The objective of this study was to determine if
polysaccharide pneumococcal vaccination was
associated with prevention of invasive
pneumococcal disease and reduced ICU admission.
Figure 3: Frequency of polysaccharide pneumococcal vaccination before hospitalization for CAP by region and overall
4
5
REFERENCES
6
• Cases of radiographically confirmed communityacquired pneumonia (CAP) with positive S.
pneumoniae culture or urinary antigen were
included.
• Associations between prior vaccination and outcome
variables were determined using multivariate logistic
regression. Confounding variables were selected
using a purposeful selection algorithm.11
• Additional analysis of vaccine compliance was
conducted by calculating frequencies of vaccination
before and after hospitalization. Compliance was
calculated overall and for each of four separate
international regions.
• Our study adds to the evidence that the
polysaccharide antigens may fail to produce the
necessary immune response to prevent severe
CAP.
RESULTS (Cont’d)
MATERIALS AND METHODS
• Data were obtained from inpatient hospital records
and collected as part of the Community-Acquired
Pneumonia Organization (CAPO) international
cohort study.
• The results also indicate that prior
polysaccharide pneumococcal vaccination does
not impact the onset of pneumococcal
bacteremia or ICU admission due to CAP.
Figure 4: Sample characteristics for total sample (n=6,924) including cases of CAP due to S. pneumoniae (n=914). Of the S.
pneumoniae cases, 168 patients had received vaccination prior to hospitalization.
Figure 5: Results of bivaraible analysis of variables associated with CAP due to S. pneumoniae.
Figure 6: Results of bivariable analysis for variables related to severity of disease, and multivariable analysis for the effect of prior
polysaccharide pneumococcal vaccination on the clinical outcomes of bacteremia and ICU admission.
1.
Ochoa-Gondar, O., Vila-Corcoles, A., Ansa, X., Rodriguez-Blanco, T., Salsench, E., de Diego, C.
Palacios, L. (2008). Effectiveness of pneumococcal vaccination in older adults with chronic
respiratory dseases: results of the EVAN-65 study. Vaccine, 26(16), 1955-1962.
2.
Moberley, S. A., Holden, J., Tatham, D. P., & Andrews, R. M. (2008). Vaccines for preventing
pneumococcal infection in adults. Cochrane Database Syst Rev(1), CD000422.
3.
Johnstone, J., Eurich, D. T., Minhas, J. K., Marrie, T. J., & Majumdar, S. R. (2010). Impact of the
pneumococcal vaccine on long-term morbidity and mortality of adults at high risk for
pneumonia. Clin Infect Dis, 51(1), 15-22.
4.
Dominguez, A., Izquierdo, C., Salleras, L., Ruiz, L., Sousa, D., Bayas, J. M., . . . Carratala, J.
(2010). Effectiveness of the pneumococcal polysaccharide vaccine in preventing pneumonia in
the elderly. Eur Respir J, 36(3), 608-614.
5.
Fisman, D. N., Abrutyn, E., Spaude, K. A., Kim, A., Kirchner, C., & Daley, J. (2006). Prior
pneumococcal vaccination is associated with reduced death, complications, and length of stay
among hospitalized adults with community-acquired pneumonia. Clin Infect Dis, 42(8), 10931101.
6.
Huss, A., Scott, P., Stuck, A. E., Trotter, C., & Egger, M. (2009). Efficacy of pneumococcal
vaccination in adults: a meta-analysis. CMAJ, 180(1), 48-58.
7.
Manzur, A., Izquierdo, C., Ruiz, L., Sousa, D., Bayas, J. M., Celorrio, J. M., . . . Carratala, J. (2011).
Influence of prior pneumococcal and influenza vaccination on outcomes of older adults with
community-acquired pneumonia.J Am Geriatr Soc, 59(9), 1711-1716.
8.
Maruyama, T., Taguchi, O., Niederman, M. S., Morser, J., Kobayashi, H., Kobayashi, T., . . .
Gabazza, E. C. (2010). Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia
and improving survival in nursing home residents: double blind, randomised and placebo
controlled trial. BMJ, 340, c1004.
9.
Mykietiuk, A., Carratala, J., Dominguez, A., Manzur, A., Fernandez-Sabe, N., Dorca, J., . . .
Gudiol, F. (2006). Effect of prior pneumococcal vaccination on clinical outcome of hospitalized
adults with community-acquired pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis,
25(7), 457-462.
10. Ramirez, J. A. (2005). Worldwide perspective of the quality of care provided to hospitalized
patients with community-acquired pneumonia: results from the CAPO international cohort
study. Semin Respir Crit Care Med, 26(6), 543-552.
11. Bursac, Z., Gauss, C., Williams, D., Hosmer, D. (2008). Purposeful selection of variables in
logistic regression. Source Code Biol Med 3: 17.