A. Ortqvist et al., RANDOMIZED TRIAL OF 23-VALENT PNEUMOCOCCAL CAPSULAR POLYSACCHARIDE VACCINE IN PREVENTION OF PNEUMONIA IN MIDDLE-AGED AND ELDERLY PEOPLE, Lancet, 351(9100), 1998, pp. 399-403
Background We assessed the effectiveness of a 23-valent pneumococcal v
accine in the prevention of pneumococcal pneumonia and of pneumonia ov
erall in nonimmunocompromised middle-aged and elderly people. Methods
The prospective, multicentre, double-blind, randomised, placebo-contro
lled trial was carried out across departments of infectious diseases a
t six tertiary-care or university hospitals in Sweden. 691 nonimmunoco
mpromised patients aged 50-85 years who had been treated as inpatients
for community-acquired pneumonia (CAP) were randomly assigned either
23-valent pneumococcal capsular polysaccharide vaccine or placebo (sod
ium chloride). We used Cox regression models to estimate the relative
risks of pneumonia overall and pneumococcal pneumonia for the placebo
group compared with the vaccine group. Findings 63 (19%) of 339 patien
ts in the vaccine group and 57 (16%) of 352 patients in the placebo gr
oup developed a new pneumonia, corresponding to a relative risk over t
ime for the placebo group compared with the vaccine group of 0.83 (95%
CI 0.58-1.12, p=0.31). Pneumococcal pneumonia was diagnosed in 16 (4.
5%) patients in the placebo group and in 19 (5.6%) in the vaccine grou
p, corresponding to a relative risk for the placebo group of 0.78 (95%
CI 0.40-1.51, p=0.45). We found no difference in the death rate betwe
en the two study groups. Interpretation The 23-valent pneumococcal pol
ysaccharide vaccine did not prevent pneumonia overall or pneumococcal
pneumonia in middle-aged and elderly individuals.