Prior pneumococcal vaccination does not prevent bacteremia or ICU admission in patients hospitalized for community-acquired pneumonia due to Streptococcus

pneumoniae: Results from the CAPO international cohort study Lauren Burke1,2, Ruth L. Carrico, PhD3, Timothy Wiemken, PhD3

University of Louisville, School of Public Health and Information Sciences1, School of Medicine2, and School of Medicine, Division of Infectious Diseases2

INTRODUCTION

MATERIALS AND METHODS

RESULTS

1: USA and Canada

2: Spain, Italy, Germany, Greece, Andorra, Portugal, Scotland, Switzerland, The Netherlands

3: Argentina, Brazil, Chile, Guatemala, Honduras, Panama, Paraguay, Peru, Puerto Rico, Uruguay, Venezuala

4: Australia, India, Israel, Lebanon, The Phillipines, China,

South Africa

CONCLUSIONS

RESULTS (Cont’d) REFERENCES

• Disease due to Streptoccocus pneumoniae, including pneumonia, is a leading cause of mortality worldwide.1

• Acute respiratory infection, including pneumonia, is the 8th leading cause of death in the United States.2

• Pneumonia due to S. pneumoniae is considered a vaccine preventable disease, there is debate regarding the effectiveness of the vaccine.3 Previous studies show inconsistent results regarding disease prevention and improved clinical outcomes.2-9

• The Community Acquired Pneumonia Organization (CAPO) international cohort study has collected information regarding pneumococcal pneumonia prevention and management since 2001.10

• The objective of this study was to determine if polysaccharide pneumococcal vaccination was associated with prevention of invasive pneumococcal disease and reduced ICU admission.

• Data were obtained from inpatient hospital records and collected as part of the Community-Acquired Pneumonia Organization (CAPO) international cohort study.

• Cases of radiographically confirmed community-acquired pneumonia (CAP) with positive S. pneumoniae culture or urinary antigen were included.

• Associations between prior vaccination and outcome variables were determined using multivariate logistic regression. Confounding variables were selected using a purposeful selection algorithm.11

• Additional analysis of vaccine compliance was conducted by calculating frequencies of vaccination before and after hospitalization. Compliance was calculated overall and for each of four separate international regions.

1 2 3

Figure 1: Illustration of the four regions included in the CAPO international cohort study and a list of countries within each region11

Figure 2: Vaccine incidence related to frequency of polysaccharide pneumococcal vaccination after hospitalization for CAP by region and overall.

Figure 3: Frequency of polysaccharide pneumococcal vaccination before hospitalization for CAP by region and overall

4 5 6

Figure 4: Sample characteristics for total sample (n=6,924) including cases of CAP due to S. pneumoniae (n=914). Of the S. pneumoniae cases, 168 patients had received vaccination prior to hospitalization.

Figure 5: Results of bivaraible analysis of variables associated with CAP due to S. pneumoniae.

Figure 6: Results of bivariable analysis for variables related to severity of disease, and multivariable analysis for the effect of prior polysaccharide pneumococcal vaccination on the clinical outcomes of bacteremia and ICU admission.

• The incidence of pneumococcal vaccination during hospital admission was 15% overall, and ranged from 8% to 17% (Europe > Latin America > North America > Africa and Asia).

• The frequency of pneumococcal vaccination prior to hospitalization was 17% overall, and ranged from 15% to 29% (Africa and Asia > North America > Europe > Latin America).

• These results indicate there is room for improvement in vaccine compliance according to recommended care guidelines for CAP.

• The results also indicate that prior polysaccharide pneumococcal vaccination does not impact the onset of pneumococcal bacteremia or ICU admission due to CAP.

• Our study adds to the evidence that the polysaccharide antigens may fail to produce the necessary immune response to prevent severe CAP.

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2. Moberley, S. A., Holden, J., Tatham, D. P., & Andrews, R. M. (2008). Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev(1), CD000422.

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8. Maruyama, T., Taguchi, O., Niederman, M. S., Morser, J., Kobayashi, H., Kobayashi, T., . . . Gabazza, E. C. (2010). Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial. BMJ, 340, c1004.

9. Mykietiuk, A., Carratala, J., Dominguez, A., Manzur, A., Fernandez-Sabe, N., Dorca, J., . . . Gudiol, F. (2006). Effect of prior pneumococcal vaccination on clinical outcome of hospitalized adults with community-acquired pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis, 25(7), 457-462.

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11. Bursac, Z., Gauss, C., Williams, D., Hosmer, D. (2008). Purposeful selection of variables in logistic regression. Source Code Biol Med 3: 17.