AIM: Estimate pneumococcal vaccine effectiveness in preventing Streptococcus pneumoniae illness in the elderly. DESIGN: Systematic review and meta-analysis. DATA SOURCE. MEDLINE, years 1964 to the 2000; EMBASE, from 1988 to the 2000; Cochrane Library, identified studies and previously published systematic reviews citations peruse, and contacts with field experts. STUDY SELECTION: Clinical trials, cohort and case-control studies, published in Spanish, English or French, that estimated pneumococcal disease rates in vaccinated or not vaccinated elderly. DATA EXTRACTION: The studies were valued independently by four investigators with predefined criteria of validity, such as results comparing rates of disease caused by serotypes included in the vaccine, random allocation, double blind design, included subjects pertaining to the same study base, and losses of less than 10% in clinical trials and 20% in observational studies. RESULTS: Eight clinical trials considered the relative risk (RR) of pneumococcal pneumonia, three did not make estimations on pneumonia originated by serotypes included in the vaccine and only one study fulfilled all the inclusion criteria. Vaccinated versus not vaccinated pneumococcal pneumonia RR was 0.86 (95%CI, 0.24 to 2.99). Vaccine effectiveness was 14% (95%CI, -199 to 76%). Ten studies performed estimations on the effectiveness of the vaccine on invasive disease by vaccine serotypes. Of these, two clinical trials and two observational studies fulfilled the required quality criteria. RR of invasive disease was of 0.68 (95%CI, 0.39-1.18); vaccine effectiveness was 32% (95%CI, 18-61%). CONCLUSIONS: No evidence was found supporting pneumococcal vaccine effectiveness to reduce or avoid S. pneumoniae disease in the elderly.

Adult↗

PubMed1999

[Impact of various strategies on the rates of flu vaccination in the elderly].

OBJECTIVE: To calculate the impact of different interventions on the rates of anti-flu vaccination in people aged 65 and over. DESIGN: Ecological study with analytical components. SETTING: Health centres and clinics in two health areas in the Community of Valencia. PATIENTS AND OTHER PARTICIPANTS: Care units, characterised by their coverage of stable nuclei of 500 or more people, total population of 415,172 inhabitants. INTERVENTIONS: Use of the communication media, personal invitations by post and telephone; follow-up of activity, discussion of results, external evaluations; registration of people to be vaccinated and prior order to nursing staff to vaccinate. MEASUREMENTS AND MAIN RESULTS: The coverage in quartiles of the previous season and the human resources per thousand inhabitants were the structural factors which best explained the vaccination rates. In the multivariate analysis, invitation by letter had relative risk (RR) of 1.062 (95% CI, 1.036-1.088); telephone call, RR 1.075 (95% CI, 1.021-1.132); discussion of external evaluations, RR 1.046 (95% CI, 1.024-1.068); and the order of vaccination to nursing staff, RR 1.056 (95% CI, 1.025-1.088). All these were associated with greater coverage. The absolute difference in coverage achieved between the care units which invited people to be vaccinated by letter and phone, at which nurses vaccinated directly, and which discussed external evaluations, and the units which did not perform these above activities, was 14 points (95% CI, 13.3-14.5), independently of the other factors. CONCLUSIONS: The previous year's coverage, human resources, invitation by letter or phone, the order to nursing to vaccinate and the discussion of external evaluations, were all associated, independently, with higher rates of vaccination.

Aged↗

PubMed1997

Reduction in hospital admissions for pneumonia in non-institutionalised elderly people as a result of influenza vaccination: a case-control study in Spain.

OBJECTIVE: To estimate the effectiveness of influenza vaccine in preventing hospital admission for pneumonia in non-institutionalised elderly people. DESIGN: This was a case-control study. SETTING: All three public hospitals in the Castellón area of Spain. PARTICIPANTS: Cases were people aged 65 or more not living in an institution who were admitted to hospital for pneumonia between November 15, 1994 and March 31, 1995. Each case was matched with two sex matched control subjects aged 65 years or older admitted to hospital in the same week for acute abdominal surgical conditions or trauma. The sampling of incident cases was consecutive. Eighty three cases and 166 controls were identified and included in the study. MEASUREMENTS: Trained interviewers completed a questionnaire for each subject on the vaccination status, smoking habits, previous diseases, health care use, social contacts, family background, the vaccination status of the family carer, home characteristics, and socioeconomic status. RESULTS: The adjusted odds ratio of the influenza vaccination preventing admission to hospital for pneumonia was 0.21 (95% confidence interval 0.09, 0.55). The variables which best explained the risk of being a case were age, intensity of social contacts, health care use, previous diseases, and the existence of a vaccinated family carer. CONCLUSIONS: Influenza vaccination reduced significantly hospital admissions for pneumonia in non-institutionalised elderly people.

Age Factors↗