The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes

RESULTS from the Community-Acquired Pneumonia Organization (CAPO) international cohort study

Timothy L. Wiemken, Ruth M. Carrico, Sabra L. Klein, Colleen Jonsson, Paula Peyrani, Robert R. Kelley, Stefano Aliberti, Francesco Blasi, Ricardo Fernandez-Gonzalez, Gustavo Lopardo, Julio A. Ramirez

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: The effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to prevent hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia (SpCAP) is controversial. Recent literature suggests that vaccine effectiveness may be influenced by sex. In this study, we define the effectiveness of prior PPV23 vaccination for the prevention of hospitalizations due to SpCAP, and evaluate the impact of sex on this effectiveness. Methods: This was a nested case-control study from the CAPO international cohort study database. SpCAP was defined as CAP plus S. pneumoniae identified in blood, bronchoalveolar lavage, sputum, or urinary antigen. Vaccination with PPV23 prior to hospitalization was defined as documented in the medical record. A propensity score-weighted logistic regression model was used to calculate odds ratios. The adjusted vaccine effectiveness (aVE) was calculated as 1-adjusted odds ratio. Results: From a total of 2688 elderly adult hospitalized patients with CAP, SpCAP was identified in 279 (10%). The overall aVE was 37% (95% CI: 10.1-55.4%, P= 0.01). For males, the aVE was 34% (95% CI:-1.0% to 57.3%, P= 0.06). For females the aVE was 68% (95% CI: 40.3-83.0%, P= 0.001). Conclusions: PPV23 protects elderly patients from hospitalization due to SpCAP, but female sex drives the effectiveness. Future analysis of vaccine trials should consider the importance of sex as a stratification factor.

Original languageEnglish (US)
Pages (from-to)2198-2203
Number of pages6
JournalVaccine
Volume32
Issue number19
DOIs
StatePublished - Apr 17 2014

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Pneumococcal Vaccines
Streptococcus pneumoniae
international organizations
cohort studies
pneumonia
Pneumonia
Hospitalization
Cohort Studies
polysaccharides
Vaccines
Organizations
vaccines
gender
Vaccination
odds ratio
Logistic Models
Odds Ratio
vaccination
Propensity Score
Bronchoalveolar Lavage

All Science Journal Classification (ASJC) codes

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes : RESULTS from the Community-Acquired Pneumonia Organization (CAPO) international cohort study. / Wiemken, Timothy L.; Carrico, Ruth M.; Klein, Sabra L.; Jonsson, Colleen; Peyrani, Paula; Kelley, Robert R.; Aliberti, Stefano; Blasi, Francesco; Fernandez-Gonzalez, Ricardo; Lopardo, Gustavo; Ramirez, Julio A.

In: Vaccine, Vol. 32, No. 19, 17.04.2014, p. 2198-2203.

Research output: Contribution to journalArticle

Wiemken, Timothy L. ; Carrico, Ruth M. ; Klein, Sabra L. ; Jonsson, Colleen ; Peyrani, Paula ; Kelley, Robert R. ; Aliberti, Stefano ; Blasi, Francesco ; Fernandez-Gonzalez, Ricardo ; Lopardo, Gustavo ; Ramirez, Julio A. / The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes : RESULTS from the Community-Acquired Pneumonia Organization (CAPO) international cohort study. In: Vaccine. 2014 ; Vol. 32, No. 19. pp. 2198-2203.
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title = "The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes: RESULTS from the Community-Acquired Pneumonia Organization (CAPO) international cohort study",
abstract = "Background: The effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to prevent hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia (SpCAP) is controversial. Recent literature suggests that vaccine effectiveness may be influenced by sex. In this study, we define the effectiveness of prior PPV23 vaccination for the prevention of hospitalizations due to SpCAP, and evaluate the impact of sex on this effectiveness. Methods: This was a nested case-control study from the CAPO international cohort study database. SpCAP was defined as CAP plus S. pneumoniae identified in blood, bronchoalveolar lavage, sputum, or urinary antigen. Vaccination with PPV23 prior to hospitalization was defined as documented in the medical record. A propensity score-weighted logistic regression model was used to calculate odds ratios. The adjusted vaccine effectiveness (aVE) was calculated as 1-adjusted odds ratio. Results: From a total of 2688 elderly adult hospitalized patients with CAP, SpCAP was identified in 279 (10{\%}). The overall aVE was 37{\%} (95{\%} CI: 10.1-55.4{\%}, P= 0.01). For males, the aVE was 34{\%} (95{\%} CI:-1.0{\%} to 57.3{\%}, P= 0.06). For females the aVE was 68{\%} (95{\%} CI: 40.3-83.0{\%}, P= 0.001). Conclusions: PPV23 protects elderly patients from hospitalization due to SpCAP, but female sex drives the effectiveness. Future analysis of vaccine trials should consider the importance of sex as a stratification factor.",
author = "Wiemken, {Timothy L.} and Carrico, {Ruth M.} and Klein, {Sabra L.} and Colleen Jonsson and Paula Peyrani and Kelley, {Robert R.} and Stefano Aliberti and Francesco Blasi and Ricardo Fernandez-Gonzalez and Gustavo Lopardo and Ramirez, {Julio A.}",
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T2 - RESULTS from the Community-Acquired Pneumonia Organization (CAPO) international cohort study

AU - Wiemken, Timothy L.

AU - Carrico, Ruth M.

AU - Klein, Sabra L.

AU - Jonsson, Colleen

AU - Peyrani, Paula

AU - Kelley, Robert R.

AU - Aliberti, Stefano

AU - Blasi, Francesco

AU - Fernandez-Gonzalez, Ricardo

AU - Lopardo, Gustavo

AU - Ramirez, Julio A.

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N2 - Background: The effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to prevent hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia (SpCAP) is controversial. Recent literature suggests that vaccine effectiveness may be influenced by sex. In this study, we define the effectiveness of prior PPV23 vaccination for the prevention of hospitalizations due to SpCAP, and evaluate the impact of sex on this effectiveness. Methods: This was a nested case-control study from the CAPO international cohort study database. SpCAP was defined as CAP plus S. pneumoniae identified in blood, bronchoalveolar lavage, sputum, or urinary antigen. Vaccination with PPV23 prior to hospitalization was defined as documented in the medical record. A propensity score-weighted logistic regression model was used to calculate odds ratios. The adjusted vaccine effectiveness (aVE) was calculated as 1-adjusted odds ratio. Results: From a total of 2688 elderly adult hospitalized patients with CAP, SpCAP was identified in 279 (10%). The overall aVE was 37% (95% CI: 10.1-55.4%, P= 0.01). For males, the aVE was 34% (95% CI:-1.0% to 57.3%, P= 0.06). For females the aVE was 68% (95% CI: 40.3-83.0%, P= 0.001). Conclusions: PPV23 protects elderly patients from hospitalization due to SpCAP, but female sex drives the effectiveness. Future analysis of vaccine trials should consider the importance of sex as a stratification factor.

AB - Background: The effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to prevent hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia (SpCAP) is controversial. Recent literature suggests that vaccine effectiveness may be influenced by sex. In this study, we define the effectiveness of prior PPV23 vaccination for the prevention of hospitalizations due to SpCAP, and evaluate the impact of sex on this effectiveness. Methods: This was a nested case-control study from the CAPO international cohort study database. SpCAP was defined as CAP plus S. pneumoniae identified in blood, bronchoalveolar lavage, sputum, or urinary antigen. Vaccination with PPV23 prior to hospitalization was defined as documented in the medical record. A propensity score-weighted logistic regression model was used to calculate odds ratios. The adjusted vaccine effectiveness (aVE) was calculated as 1-adjusted odds ratio. Results: From a total of 2688 elderly adult hospitalized patients with CAP, SpCAP was identified in 279 (10%). The overall aVE was 37% (95% CI: 10.1-55.4%, P= 0.01). For males, the aVE was 34% (95% CI:-1.0% to 57.3%, P= 0.06). For females the aVE was 68% (95% CI: 40.3-83.0%, P= 0.001). Conclusions: PPV23 protects elderly patients from hospitalization due to SpCAP, but female sex drives the effectiveness. Future analysis of vaccine trials should consider the importance of sex as a stratification factor.

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