Jc. Butler et al., PNEUMOCOCCAL POLYSACCHARIDE VACCINE EFFICACY - AN EVALUATION OF CURRENT RECOMMENDATIONS, JAMA, the journal of the American Medical Association, 270(15), 1993, pp. 1826-1831
Objective.-To determine pneumococcal polysaccharide vaccine efficacy i
n selected populations at risk for serious pneumococcal infection for
whom vaccination is currently recommended and to assess duration of pr
otection after vaccination. Design.-Vaccine efficacy was estimated usi
ng indirect cohort analysis to compare the proportion of pneumococcal
infections caused by serotypes included in the vaccines of vaccinated
and unvaccinated persons who were identified during 14 years of nation
al surveillance. Setting.-Hospital laboratories in the United States t
hat submitted pneumococcal isolates to the Centers for Disease Control
and Prevention between May 1978 and April 1992. Participants.-A total
of 2837 persons older than 5 years who had pneumococcus isolated from
blood or cerebrospinal fluid. Results.-Overall efficacy for preventin
g infection caused by serotypes included in the vaccine was 57% (95% c
onfidence interval [CI], 45% to 66%). Efficacy among persons with diab
etes mellitus was 84% (95% CI, 50% to 95%); with coronary vascular dis
ease, 73% (95% CI, 23% to 90%); with congestive heart failure, 69% (95
% CI, 17% to 88%); with chronic pulmonary diseases, 65% (95% CI, 26% t
o 83%); and with anatomic asplenia, 77% (95% CI, 14% to 95%). Efficacy
was not documented for patients with alcoholism or cirrhosis, sickle
cell disease, chronic renal failure, lymphoma, leukemia, or multiple m
yeloma, although sample sizes were small for these groups. Efficacy fo
r immunocompetent persons older than 65 years was 75% (95% CI, 57% to
85%). Efficacy did not decline with increasing interval after vaccinat
ion: 5 to 8 years after vaccination it was 71% (95% CI, 24% to 89%), a
nd 9 years or more after vaccination it was 80% (95% CI, 16% to 95%).
Conclusions.-Intensified efforts to improve pneumococcal vaccine cover
age among certain populations for whom vaccination is currently recomm
ended is indicated, but universal revaccination is not warranted at th
is time.