Efficacy of 23-valent pneumococcal polysaccharide vaccine in preventing community-acquired pneumonia among immunocompetent adults: A systematic review and meta-analysis of randomized trials |
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| Affiliation: | 1. Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China;2. Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;1. Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, WKZ, Utrecht, Netherlands;1. Naval Health Research Center, Operational Infectious Diseases Department, 140 Sylvester Road, San Diego, CA 92106-3521, USA;2. Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20901, USA;3. Hologic, Inc., 10210 Genetic Center Drive, San Diego, CA 92121, USA;4. Mayo Vaccine Research Group, College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA;5. Clinical Investigation Program, Naval Hospital Camp Pendleton, H200 Room 4179, Camp Pendleton, CA 92055, USA;6. Division of Infectious Diseases, Global Health Institute, & Nicholas School of the Environment, Duke University, 315 Trent Rd, Durham, NC 27710, USA;1. University of Louisville School of Medicine, Division of Infectious Diseases, Louisville, KY, United States;2. University of Louisville Clinical and Translational Research Support Unit, Louisville, KY, United States;3. Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, United States;4. University of Louisville School of Medicine, Department of Microbiology and Immunology, Louisville, KY, United States;5. Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy;6. Dipartimento di Fisiopatologia e dei Trapianti, University of Milan, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy;7. Pulmonary Training Program, San Juan City Hospital, Puerto Rico;8. Department of Infectious Diseases, Hospital Profesor Bernardo Houssay, Vicente López, Buenos Aires, Argentina;1. Dept Gastroenterology and Hepatology, Charité-Universitätsmedizin Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany;2. Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy;3. CHU Bordeaux, Clinical Gerontology, France;4. CNRS, RMSB, UMR 5536, France;5. University Bordeaux, RMSB, UMR 5536, Bordeaux, France;6. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 12, 40126 Bologna, Italy;7. Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy;8. Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy;9. Biostatistical Center INRCA, Via S. Margherita 5, 60100 Ancona, Italy;10. R&D, VoxNet CEO, Via Giovanni Paisiello 32, 00198 Rome, Italy;11. Actial Farmaceutica Lda, Praca Severiano Ferraz 258, 09000 082 Funchal, Portugal;12. CHU Bordeaux, Clinical Gerontology, 33000 Bordeaux, France;13. Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria;14. Dept Microbiology and Hygiene, Charité-Universitätsmedizin Berlin, CBF, Hindenburgdamm 27, 12203 Berlin, Germany;1. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;2. Independent Researcher, Calgary, Alberta, Canada;3. Departments of Medicine, Microbiology, Immunology & Infectious Diseases, Pathology & Laboratory Medicine, Snyder Institute for Chronic Diseases and O''Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada;4. Health Sciences Library and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada |
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| Abstract: | BackgroundData on the efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing adult community-acquired pneumonia (CAP) among the target population of individuals aged over 65 years and high-risk individuals aged 19–64 years are conflicting. As the Advisory Committee on Immunization Practices (ACIP) has recently demonstrated PPV-23 is likely beneficial to immunocompromised adults by the Grading, Assessment, Development, and Evaluation (GRADE) framework, we conducted meta-analysis to examine its efficacy in an immunocompetent population.MethodsWe searched the PUBMED, EMBASE, and Cochrane Library databases for randomized trials. Overall relative risks (RRs) with 95% confidential intervals (CIs) were calculated, and the Cochrane Q test (p, I2) was performed. Outcomes were assessed by the GRADE framework.ResultsSeven randomized trials involving 156,010 participants were included in this meta-analysis. High-quality evidence revealed that PPV-23 was weakly associated with the prevention of all-cause pneumonia ([RR] 0.87, [95%CI] 0.76–0.98, p = 0.11, I2 = 43%), especially among the target population ([RR] 0.72, [95%CI] 0.69–0.94, p = 0.58 I2 = 0%), the elderly group aged over 40 years ([RR] 0.80, [95%CI] 0.69–0.94) and the Japanese population ([RR] 0.72, [95%CI] 0.59–0.88, p = 0.24, I2 = 30%). The target population included adults aged over 65 years and patients at high risk of pneumonia due to chronic lung disease, chronic obstructive pulmonary disease or living in a nursing home. Protective trends of PPV-23 in the outcomes of pneumococcal pneumonia ([RR] 0.54, [95%CI] 0.18–1.65, p = 0.01, I2 = 77%) and mortality due to pneumonia ([RR] 0.67, [95%CI] 0.43–1.04, p = 0.67, I2 = 0%) were observed, although the results were statistically insignificant, possibly due to the small number of trials included. PPV-23 did not prevent all-cause mortality ([RR] 1.04, [95%CI] 0.87–1.24, p = 0.95, I2 = 0%).ConclusionsPPV-23 provided weak protection against all-cause pneumonia in an immunocompetent population, especially among the target population. The additional benefit of PPV-23 in preventing CAP further supports its application in the target population. |
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| Keywords: | 23-Valent pneumococcal polysaccharide vaccine Community-acquired pneumonia Efficacy Meta-analysis Immunocompetent |
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