Pneumococcal Vaccine Does Not Appear To Protect Against Pneumonia
Main Category: Respiratory / AsthmaAlso Included In: Immune System / Vaccines; Infectious Diseases / Bacteria / Viruses
Article Date: 06 Jan 2009 - 4:00 PDT
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Commonly used pneumococcal polysaccharide vaccines do not appear to be effective for preventing pneumonia, found a study by a team of researchers from Switzerland and the United Kingdom.
In many industrialized countries, polysaccharide pneumococcal vaccines (PPVs) are currently recommended to help prevent pneumococcal disease in people aged 65 and over and for younger people with increased risk due to conditions like HIV. Studies have shown conflicting results regarding the efficacy of PPV.
The study, a systematic review and meta-analysis, looked at 22 clinical trials, reviews and meta-analyses and more than 100,000 participants from countries in North America as well as India, Africa, Latin America and the Caribbean. Unlike other similar studies the authors examined the reasons why different clinical trials produced different results. They found that the quality of the studies substantially affected the results. When only high quality trials were included, there was no evidence that PPVs could prevent pneumonia. The study adds to the ongoing debate around effectiveness of the vaccine.
"Policy makers may therefore wish to reconsider their current recommendations for PPV, especially where routine pneumococcal conjugate immunization has been introduced," conclude Dr. Matthias Egger from the University of Bern, Switzerland and coauthors.
However, in a related commentary, Dr. Ross Andrews and coauthor from the Menzies School of Health Research, Darwin, Australia state that the researchers' conclusions exceed the evidence presented. They caution that there should be no change in vaccine policy in countries that recommend PPV to prevent invasive pneumococcal disease.
"Efficacy of pneumococcal vaccination in adults: a meta-analysis"
Anke Huss, PhD, Pippa Scott, MSc, Andreas E. Stuck, MD, Caroline Trotter, PhD and Matthias Egger, MD MSc
CMAJ • January 6, 2009; 180 (1). doi:10.1503/cmaj.080734
Click here to view abstract online
Canadian Medical Association Journal (CMAJ)
http://www.cmaj.ca
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Pneumo Inflammation
posted by Dan on 6 Jan 2009 at 12:44 pmPneumonia is an inflammation and consolidation f lung tissue to due to an infectious agent- typically a bacteria or a virus, and is usually acquired in a community setting. Bacterial pneumonia occurs more often by a microbe called S. Pneumo. Half of all people infected with this bacteria show no symptoms. Compared 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.
Approximately 2 to 5 million 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 another bacteria that often is tough to eliminate. Some bacteria, such as MRSA or VRE, are resistant to most antibiotics, so treatment of this type of pneumonia is more difficult than pneumonia acquired in the community from another microbe.
Also, treatment for nosocomial pneumonia may require a longer period of treatment and recovery as well. About 25 percent of ICU patients without pneumonia acquire nosocomial pneumonia while there.
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.
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. Also, 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.
Dan Abshear
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