Abstract

Vaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations. The open-label, prospective, observational cohort study involved 302 male patients aged ≥ 45 years: PCV13 group (n = 123); PPV23 group (n = 32); and vaccine-naïve group (n = 147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test. Vaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination was registered in 47% of patients in the PPV23 group, versus 3.3% of patients in the PCV13 group (p < 0.001); COPD exacerbations—in 81.3% versus 23.6%, respectively (p < 0.001). Vaccination with PCV13 significantly reduced and maintained the BODE index over the 5-year follow-up period. Although both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years who received PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.

Highlights

  • Chronic obstructive pulmonary disease (COPD) is a common disorder characterized by ongoing respiratory symptoms and airflow obstruction caused by airway and/or alveolar abnormalities typically emerging after substantial exposure to hazardous particles and g­ ases[1]

  • According to the choice of patients, agreed with their physician, and their consent to any type of vaccination, the patients were allocated into three groups: patients vaccinated with the 23-valent vaccine (PPV23 group), those vaccinated with the 13-valent vaccine (PCV13 group), and vaccine-naïve patients

  • Over the period between October and December 2012, 150 patients were vaccinated with PCV13; 32 patients, with PPV23

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Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a common disorder characterized by ongoing respiratory symptoms and airflow obstruction caused by airway and/or alveolar abnormalities typically emerging after substantial exposure to hazardous particles and g­ ases[1]. In real-life practice, a significant percentage of patients continue smoking in spite of the physician’s recommendations For this very reason, prevention of COPD exacerbations is the key factor for rehabilitation for these patients, since it is associated with improving clinical symptoms, quality of life, as well as patients’ physical and emotional status. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends influenza vaccination at evidence A level due to its ability to reduce hospitalization and mortality rates, and pneumococcal vaccination at evidence B level to prevent community-acquired p­ neumonia[1] In this case, the long-term consequences of any of these infections, in particular in elderly patients, may be very serious, up to disability and an increased risk of death. Often, only the polysaccharide pneumococcal vaccine was utilized in these studies

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