Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk – A Systematic Review and Meta-AnalysisReport as inadecuate




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Background

Pneumococcal community-acquired pneumonia pCAP is the most frequent form of pneumonia. The elderly and adults with underlying diseases are at an increased risk of developing pCAP. The 23-valent pneumococcal polysaccharide vaccine PPV23 was licensed over 30 years ago and is recommended as the standard intervention in many countries across the globe, although its efficacy continues to be debated. We performed a meta-analysis of randomized controlled trials RCTs to investigate the effect of PPV23 for preventing pCAP in adults ≥60 years of age.

Methods

An existing Cochrane Review was updated to Oct 2014 using a systematic literature search to select appropriate RCTs. DerSimonian and Laird random-effects meta-analyses were performed and odd ratios OR with 95%-confidence intervals CI and p-values were calculated for the descriptive analyses. Reasons for heterogeneity were explored by subgroup analyses.

Results

Meta-analysis of PPV23 efficacy included four studies. Three of them did not demonstrate efficacy for PPV23. The body of evidence indicated statistically significant heterogeneity I2 = 78%, p = 0.004 that could be explained by subgroup analysis by -study setting-. Further effect modifiers for pCAP were -continent of trial- p<0.01, and -method of pneumococcal diagnostics- p = 0.001. Subgroup analyses revealed that the only study showing efficacy for PPV23 was an outlier. Overall, the validity of the meta-analytic PPV23 efficacy assessment was confirmed by the meta-analysis of all-cause CAP including six studies.

Discussion

Inconsistencies in PPV23 treatment effects to prevent pCAP could solely be explained by one outlier study that was performed in nursing homes in Japan. The effect modifier -method of pneumococcal diagnostics- should be interpreted carefully, since methodological weaknesses are not restricted to one special method only, which would justify the exclusion of certain studies. Overall, we conclude from our meta-analysis that to date there is no proof that PPV23 can prevent pCAP in a general, community-dwelling elderly population.



Author: Julia Schiffner-Rohe , Annika Witt, Jana Hemmerling, Christof von Eiff, Friedrich-Wilhelm Leverkus

Source: http://plos.srce.hr/



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