Injectable vaccines for preventing pneumococcal infection in patients with chronic obstructive pulmonary disease (Intervention Review)

Background As chronic obstructive pulmonary disease (COPD) progresses, exacerbations can occur with increasing frequency.One goal of therapy is to prevent these exacerbations, thereby reducing morbidity and associated healthcare costs. Pneumococcal vaccinations are one strategy for reducing the risk of infective exacerbations. Objectives To determine the safety and efficacy of pneumococcal vaccination inCOPD.The primary outcomes assessedwere episodes of pneumonia and acute exacerbations. Secondary outcomes of interest included hospital admissions, adverse events related to treatment, disability, change in lung function, mortality, and cost effectiveness. Search strategy We searched the Cochrane Airways Group COPD trials register and the databases CENTRAL, MEDLINE and EMBASE using prespecified terms. The latest searches were performed in March 2010. Selection criteria Randomised controlled trials assessing the effects of injectable pneumococcal vaccine in people with COPD were included. Data collection and analysis Two review authors independently extracted data and three review authors independently assessed trial quality. Main results Seven studies were identified that met the inclusion criteria for this review and were included in the 2010 review update. Two older trials used a 14-valent vaccine and five more recent trials used a 23-valent injectable vaccine. In six studies involving 1372 people, the reduction in likelihood of developing pneumonia with pneumococcal vaccination compared to control did not achieve statistical significance, the odds ratio (OR) was 0.72 (95%confidence interval (CI) 0.51 to 1.01), with moderate heterogeneity present between studies. The reduction in likelihood of acute exacerbations of COPD from two studies involving 216 people was not statistically significant (Peto OR 0.58; 95% CI 0.30 to 1.13). Of the secondary outcomes for which data were available there was no statistically significant effect for reduction in hospital admissions (two studies) or emergency department visits (one study). There was no significant reduction in pooled results from three studies involving 888 people for odds of all-cause mortality for periods up to 48 months post-vaccination (OR 0.94; 95% CI 0.67 to 1.33), or for death from cardiorespiratory causes (OR 1.07; 95% CI 0.69 to 1.66).