Clinical effectiveness of pneumococcal vaccine - Meta-analysis

OBJECTIVE To determine the clinical effectiveness of pneumococcal vaccine. DATA SOURCES Computerized searches of MEDLINE, EMBASE, and SCISEARCH databa ses were performed, reference lists of retrieved articles were reviewed, an d first authors of published studies were contacted. STUDY SELECTION Studies of use of pneumococcal vaccines in adults were incl uded if the study design was a randomized or quasi-randomized controlled tr ial and at least one of the following clinical outcomes was reported: vacci ne-type systemic pneumococcal infection, systemic pneumococcal infection, v accine-type pneumococcal pneumonia, pneumococcal pneumonia, non-vaccine-typ e pneumococcal pneumonia. SYNTHESIS Study quality was assessed and descriptive information concerning the study populations, interventions, and outcome measurements was extract ed for 13 trials involving more than 65000 patients. Estimates of vaccine e fficacy, based on a meta-analysis of randomized and quasi-randomized trials , were determined for clinical outcomes. CONCLUSIONS Vaccination with pneumococcal polysaccharide vaccine can be exp ected to reduce the risk of systemic infection due to pneumococcal types in cluded in the vaccine by 83% and systemic infection due to all pneumococci by 73%. We found no evidence that the vaccine was less efficacious for the elderly, institutionalized people, or those with chronic disease.