Community-acquired pneumonia: combined pneumococcal/influenza vaccinations were no better than influenza alone.

Clinical bottom line (level 1b-)

  1. Elderly patients who were given a pneumococcal and influenza vaccination had no clear difference in occurrence of any pneumonia, than those given influenza vaccine alone.
  2. Elderly patients who were given a pneumococcal and influenza vaccination had no clear difference in pneumococcal pneumonia.
Koivula et al: American Journal of Medicine 1997; 103: 281-290
Expires March 2003

The study

Single-blinded ?concealed randomised trial with intention-to-treat
Setting: population-based, Finland

2837 patients (aged 47% 70 years old or older, 63% female) Elderly patients in the population of a small town.

Excluded if
  • <60 years old


    • Note:
  • 65% of patients were classified as low-risk, 31% as increased-risk and 4% as high-risk category.


    • Control Group: (n = 1473, 1473 analysed): influenza vaccine (Vaxigrip or Flupar-Vaccin)
    Experimental Group: (n = 1364, 1364 analysed): 14-valent Pneumovax (pneomococcal vaccine) and an influenza vaccine

    100% followed for 3 years
    Outcome notes:
    • all pneumonias : based on radiological findings.

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    all pneumonias weeks 64
    (4.34%)    		 69
    (5.06%)    		 -16.0%
    (-62.0% to 16.0%)    		 -0.71%
    (-2.27% to 0.85%)    		 -140
    (NNT = 118 to infinity;
    NNH = 44 to infinity)
    pneumococcal pneumonia 3 years 33
    (2.24%)    		 26
    (1.91%)    		 15.0%
    (-42.0% to 49.0%)    		 0.33%
    (-0.71% to 1.38%)    		 299
    (NNT = 72 to infinity;
    NNH = 140 to infinity)

  • Overall vaccine efficacy against pneumococcal pneumonia was 15% (CI -43% to 50%), but in the high-risk group it was 59% (CI 6% to 82%).

    • Comments

    1. Pneumococcal plus influenza vaccines may be efficacious in patients who are at high-risk of pneumococcal pneumonia.
    2. The study is too small to show any clear difference in pneumonia between the two groups.
    3. 29% of the pneumonias were hospital- or institution-acquired.

    Citation

    1. Koivula I, Sten M, Leinonen M, et al: Clinical efficacy of pneumococcal vaccine in the elderly: A randomized, single-blind population-based trial. American Journal of Medicine 1997; 103: 281-290
    Search Terms: pneumonia and vaccination in Medline
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient elderly
    Intervention or Exposure pneumococcal and influenza vaccines
    Comparison influenza vaccine alone
    Outcome pneumococcal pneumonia