Home Original News Review: Pneumococcal vaccination does not prevent pneumonia or death in adults
Review: Pneumococcal vaccination does not prevent pneumonia or death in adults PDF Print E-mail
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Written by Roman Bystrianyk   
Tuesday, 16 November 2004 00:00

In the July/August issue of the ACP Journal Club the author examined the question of whether the pneumococcal vaccination was effective in preventing disease or death in adults. Fifteen randomized controlled trials (RCTs) were examined. This included 75,197 patients with a follow-up ranging from 18 months to 4 years.

The analysis showed that, “11 trials that evaluated all-cause mortality showed no benefit of vaccination. Results for pneumococcal pneumonia and pneumonia mortality were heterogeneous, with more recent trials showing no effect.” The conclusion was, “Pneumococcal vaccination is not effective in preventing disease or death in adults.”

Infection with streptococcus pneumonia is a major cause of mortality, especially for the very young and old. For example, at age 50 the risk of pneumococcal disease is 5 per 100,000 and by age 85 it is 50-60 per 100,000. When the first pneumococcal vaccines were introduced in the mid-1940s the streptococcus organism was sensitive to penicillin, but now resistance to penicillin is approximately 35%.

The author notes that the vaccine is still recommended for patients with various medical conditions such as profound immune compromise, diabetes, history of smoking, alcoholism, or even previous hospital admission. He notes that insufficient numbers have been studied in these groups and therefore it cannot be completely ruled out that the vaccine maybe effective in these groups.

The author concludes, “As S. pneumonia increases its resistance to B-lactam antibiotics, physicians must realize that the current pneumococcal vaccine should not be relied on to reduce the incidence or mortality of pneumococcal pneumonia. It is unlikely that expansion of use of the current vaccination to the general population would be of any benefit.”

Source: ACP Journal, July/August 2004


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Pneumonia Thoughts

Pneumonia is an inflammation and consolidation of lung tissue to due to an infectious agent, such as a bacteria, or virus. Most pneumonia cases are usually acquired in a community setting .

Bacterial pneumonia occurs more often due to bacteria called S. Pneumo. About half of all people infected with this bacteria show no overt symptoms.

Also, in comparison with viral pneumonia, bacterial pneumonia has a shorter duration and is also more severe in the damage the bacteria can do to the patient. If left untreated, pneumonia can lead to the critical diseases of meningitis or sepsis, if not death. In fact, pneumonia was the number one cause of death in the United States before the advent of antibiotics.

Approximately 2 million, if not more, people acquire pneumonia every year. 40 to 60 thousand people die due to pneumonia every year, and pneumonia is the most common infectious cause of death that exists. More men get pneumonia than women.

About 20 percent of CAP cases are viral rather than bacterial. So most of the time, an antibiotic will be needed for the pneumonia patient. Also, about 10 million doctor visits are due to CAP and the symptoms from the disease.

Pneumonia acquired while a patient is in a medical institution for another medical reason is called nosocomial pneumonia. Often, the symptoms are more severe, as the patient usually has another serious medical issue that is being treated in the medical facility as they acquire this type of pneumonia.

If this type of pneumonia is acquired at such a location, it usually happens after the first 48 hours of a patient being in such a facility. Also, the microbe that causes nosocomial pneumonia is usually S. Aureus, according to others.

However, frequently the cause of pneumonia is by resistant bacteria that are difficult to kill, as they are shielded from adaptation, these bacteria, from the many existing antibiotics historically used as therapy for patients invaded by bacteria. Such bacteria, as MRSA or VRE, are most resistant to most antibiotics.
Treatment for nosocomial pneumonia usually requires a longer period to restore the health of a patient with this diagnosis. About 25 percent of ICU patients without pneumonia acquire nosocomial pneumonia while there for another medical issue.

Symptoms for the typical pneumonia patient may be a fever, a high heart rate, a productive cough, and inflamed lungs noted on an X-ray. A sputum sample is usually obtained from the suspected patient in order to determine what is causing the pneumonia.

If it is bacterial, antibiotic therapy is initiated for a certain length of time to cure the infection. At the same time, the health care provider should rule out lung cancer or tuberculosis as the provider is assessing the patient. Chest X-Rays usually are taken to rule out such diseases.

Patients who are suspected or are diagnosed with community acquired pneumonia (CAP) are often started an antibiotic regimen from what is called the macrolide class of antibiotics. Macrolides have been proven to shorten the length of time the disease exists in the patient who has pneumonia.

How serious CAP is with a patient can be determined by what is called a risk stratification point system- which lists various symptoms and conditions that may be present in the suspected patient who may have pneumonia.

Points are assigned to these symptoms, and the severity of them regarding the disease of pneumonia. If the point number exceeds 90 points, the pneumonia patient is admitted to a hospital for more aggressive treatment and evaluation. About a third of all patients with community acquired pneumonia require hospitalization.

Elderly patients usually experience this type of severity with their CAP illness, as well as those people with compromised immune systems for whatever reason. Also, primary care physicians diagnose and treat typical pneumonia in the United States. In the United States, about 2 million or more people acquire pneumonia, and over 4 thousand people die from this disease every year.

Worldwide, about 2 million children less than 5 years of age die every year due to pneumonia. Two pneumonia vaccinations are available presently. It has recently been proven that the polysaccharide pneumonia vaccine is not useful in preventing pneumonia. However, the conjugate pneumonia vaccine has been shown to prevent the disease, according to recent studies.

The effective vaccine has experienced greater worldwide access recently to prevent what may be a very deadly disease without prevention and treatment, as it is believed to protect well over 50 percent of people who receive this vaccination from pneumonia.


Dan Abshear

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Last Updated on Friday, 11 September 2009 16:25