Ten-year analysis of the efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease

Q4 Medicine

Pulmonologiya Pub Date : 2023-12-12 DOI:10.18093/0869-0189-2023-33-6-750-758

G. Ignatova, S. Avdeev, V. Antonov, E. V. Blinova

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引用次数: 0

Abstract

Major problems in the course of chronic obstructive pulmonary disease (COPD) include frequent exacerbations and related deaths. The use of pneumococcal vaccines, primarily a 13-valent polysaccharide conjugate vaccine, is a generally recognized tool for reducing the number of exacerbations.The aim of the study was to analyze the prospective clinical efficacy of vaccine prophylaxis with conjugated pneumococcal vaccine Prevenar-13 (PCV13) in patients with COPD over 10 years.Methods. A total of 362 male patients who were treated or monitored at the Regional Pulmonological Center of Chelyabinsk in 2012 – 2022 were enrolled in the study. The main efficacy endpoints of observation over 10 years were: the dynamics of dyspnea (mMRC score), forced expiratory volume in 1st second, the number of exacerbations, hospitalizations, the number of pneumonias. After confirming the diagnosis of COPD, the patients were divided into two observation groups. The first group (n = 150) included patients vaccinated with PCV13. The second group (n = 212) included patients with COPD who had not received pneumococcal vaccination for various reasons.Results. Severe forms of the disease and frequent exacerbations predominated in both groups. 96 (27%) deaths were recorded in the PCV13-vaccinated group, and 171 (47%) deaths in the unvaccinated group. The difference between vaccinated and unvaccinated is statistically significant (p < 0.05). In the unvaccinated patients, there was a steady progression of shortness of breath with an increase by 12% compared to baseline (p < 0.05) by the 10th year. A positive trend in FEV1 was noted in patients vaccinated with PCV13. They also showed a significant decrease in BODE prognostic index.Conclusion. The use of PCV13 allows for stabilization of the main clinical and functional indicators of the respiratory system in patients with COPD in the long term (at least 10 years of follow-up). Vaccination maintains a low risk of adverse events according to the BODE index; an increase in patient survival was noted over a 10-year horizon (odds ratio – 2.35; 95% confidence interval – 1.45; 3.77), including cases with acute viral damage with COVID-19 (COronaVIrus Disease 2019).

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慢性阻塞性肺病患者接种肺炎球菌感染疫苗的十年疗效分析

慢性阻塞性肺病（COPD）病程中的主要问题包括频繁的病情加重和相关死亡。使用肺炎球菌疫苗（主要是 13 价多糖结合疫苗）是公认的减少病情加重次数的工具。本研究的目的是分析慢性阻塞性肺病患者接种肺炎球菌结合疫苗 Prevenar-13 (PCV13) 预防疫苗 10 年来的前瞻性临床疗效。该研究共纳入了2012-2022年在车里雅宾斯克地区肺病中心接受治疗或监测的362名男性患者。观察10年的主要疗效终点是：呼吸困难的动态变化（mMRC评分）、第一秒用力呼气量、病情加重次数、住院次数、肺炎次数。在确诊慢性阻塞性肺病后，患者被分为两个观察组。第一组（n = 150）包括接种 PCV13 疫苗的患者。第二组（n = 212）包括因各种原因未接种肺炎球菌疫苗的慢性阻塞性肺病患者。两组患者均以病情严重和频繁恶化者居多。接种 PCV13 疫苗组有 96 人（27%）死亡，未接种组有 171 人（47%）死亡。接种疫苗组和未接种疫苗组之间的差异具有统计学意义（P < 0.05）。在未接种疫苗的患者中，呼吸急促的情况持续恶化，到第 10 年时，与基线相比增加了 12%（p < 0.05）。接种 PCV13 的患者的 FEV1 呈上升趋势。他们的 BODE 预后指数也明显下降。接种 PCV13 可使慢性阻塞性肺病患者呼吸系统的主要临床和功能指标长期（至少随访 10 年）保持稳定。根据BODE指数，接种疫苗可保持较低的不良事件风险；在10年的时间里，患者的存活率有所提高（几率比-2.35；95%置信区间-1.45；3.77），其中包括COVID-19（慢性阻塞性肺疾病2019）急性病毒损害病例。

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来源期刊

Pulmonologiya Medicine-Pulmonary and Respiratory Medicine

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： The aim of this journal is to state a scientific position of the Russian Respiratory Society (RRS) on diagnosis and treatment of respiratory diseases based on recent evidence-based clinical trial publications and international consensuses. The most important tasks of the journal are: -improvement proficiency qualifications of respiratory specialists; -education in pulmonology; -prompt publication of original studies on diagnosis and treatment of respiratory diseases; -sharing clinical experience and information about pulmonology service organization in different regions of Russia; -information on current protocols, standards and recommendations of international respiratory societies; -discussion and consequent publication Russian consensus documents and announcement of RRS activities; -publication and comments of regulatory documents of Russian Ministry of Health; -historical review of Russian pulmonology development. The scientific concept of the journal includes publication of current evidence-based studies on respiratory medicine and their discussion with the participation of Russian and foreign experts and development of national consensus documents on respiratory medicine. Russian and foreign respiratory specialists including pneumologists, TB specialists, thoracic surgeons, allergists, clinical immunologists, pediatricians, oncologists, physiologists, and therapeutists are invited to publish article in the journal.