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1 October 2006

Volume 43, Number 7
Clinical Infectious Diseases 2006;43:860–868
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4307-0010$15.00
DOI: 10.1086/507340
MAJOR ARTICLE

Protective Effects of the 23‐Valent Pneumococcal Polysaccharide Vaccine in the Elderly Population: The EVAN‐65 Study

Angel Vila‐Córcoles,1

Olga Ochoa‐Gondar,1

Imma Hospital,1

Xabier Ansa,1

Angels Vilanova,2

Teresa Rodríguez,3

Carl Llor,1 and the

EVAN Study Groupa

1Primary Care Service of Tarragona‐Valls, Catalonian Health Institute, and 2Department of Laboratory and Microbiology, Joan XXIII Hospital, Tarragona, and 3Department of Statistic and Research of IDIAP Jordi Gol i Gurina, Barcelona, Spain

Background.The 23‐valent polysaccharide pneumococcal vaccine (PPV) is currently recommended for elderly persons and persons who are at high risk of infection. However, the effectiveness of the 23‐valent PPV remains controversial. We assessed the effectiveness of this vaccine in older adults.

Methods.A prospective cohort study was conducted from January 2002 through April 2005; it included all community‐dwelling individuals aged 65 years who were assigned to 1 of 8 primary health care centers in Tarragona, Spain (11,241 subjects). The primary outcomes were invasive pneumococcal disease, pneumococcal pneumonia, overall pneumonia rate, and death due to pneumonia. All cases were validated by a check of the clinical records. The association between pneumococcal vaccination and the risk of each outcome was evaluated by means of multivariate Cox proportional hazard models, adjusted for age, sex, comorbidity, immunocompetence, and influenza vaccine status.

Results.Pneumococcal vaccination was associated with significant reductions in the risk of hospitalization for pneumonia (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.59–0.92) and in the overall pneumonia rate (HR, 0.79; 95% CI, 0.64–0.98). The incidence of invasive pneumococcal disease was low (64 cases per 100,000 person‐years), and a considerable protective effect against invasive pneumococcal disease did not attain statistical significance (HR, 0.60; 95% CI, 0.22–1.65). However, the vaccine showed a significant effectiveness of 45% to prevent pneumococcal pneumonia (HR, 0.55; 95% CI, 0.34–0.88). Finally, vaccination was associated with a significant 59% reduction in the risk of death due to pneumonia among vaccinated subjects (HR, 0.41; 95% CI, 0.23–0.72)

Conclusions.These results indicate that the 23‐valent PPV effectively prevented pneumococcal pneumonia (with or without bacteremia) and decreased the rates of overall pneumonia and of mortality due to pneumonia in older adults, providing new arguments for systematic vaccination in the elderly population.

Received 19 April 2006; accepted 1 June 2006; electronically published 21 August 2006.

Reprints or correspondence: Dr. A. Vila‐Corcoles, Institut Catala de la Salut, Prat de la Riba 39, Tarragona 43001, Spain ().

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