Pneumonia vaccination and death due to all-causes and pneumonia

[Guest guest]

Hi All,

That all-cause death reduction should be even greater after vaccination than

death due to pneumonia surprised me. I do not know why I should go against

the odds.

Cheers, Al.

Gerontology 2003;49:246-250

Impact of Pneumococcal Vaccination on Morbidity and Mortality of Geriatric

Patients: A Case-Controlled Study

WEB-URL : http://www.karger.com/doi/10.1159/000070405

Wagner, Wolfgang Popp, Posch, Clemens Vlasich, Angelika

Rosenberger-Spitzy

Keywords : Pneumococcal vaccination; Pneumonia; Elderly, vaccination

Abstract :

Background: Infections due to Streptococcus pneumoniae are the major

cause of adult community-acquired pneumonia, especially in elderly

persons with chronic medical conditions. Despite their

well-documented efficacy against bacteraemic disease and deaths in

the elderly population, pneumococcal polysaccharide vaccines are

still very much underused.

Objective: A retrospective,

case-controlled study was performed to investigate the impact of

vaccination with a polysaccharide pneumococcal vaccine, together with

other risk factors, on the incidence of pneumonia and deaths in

patients in a long-stay geriatric hospital.

Methods: Subjects were

1,077 residents in a long-stay geriatric hospital in Vienna, Austria,

including 359 patients diagnosed as having pneumonia during the

period from July 1996 to October 1998 and 718 control subjects. Two

controls resident in the hospital during the same time period were

matched for each case according to demographic characteristics,

chronic illness, and duration of stay in the geriatric ward. The

vaccination status was established for all subjects. A logistic

regression analysis was performed to assess the efficacy of

vaccination and the impact of other cofactors on disease and death.

Results: In cases and controls, 514 (47.7%) had received a

pneumococcal vaccine within 2 years prior to the study. There were no

differences in demographic characteristics, underlying medical

conditions, or duration of stay in the hospital between vaccinated

and non-vaccinated patients. In patients diagnosed with pneumonia,

66% were unvaccinated. Logistic regression analysis showed that

vaccination significantly decreased the risk of pneumonia (odds ratio

0.279; p < 0.0001). Of the cofactors tested, only gender (lower risk

in males) and diabetes mellitus (higher risk) had any impact on

disease risk and vaccine efficacy. There appeared to be a highly

significant effect of vaccination, reducing the risk of all deaths

(odds ratio 0.269; p < 0.0001) and deaths due to pneumonia (odds

ratio 0.331; p < 0.0001).

Conclusion: This study showed that

vaccination with a polysaccharide pneumococcal vaccine is effective

in all groups of geriatric subjects and has a consequential value for

health and well-being of elderly institutionalized patients.

Alan Pater, Ph.D.; Faculty of Medicine; Memorial University; St. 's, NL

A1B 3V6 Canada; Tel. No.: (709) 777-6488; Fax No.: (709) 777-7010; email:

apater@...