Influence of Prior Pneumococcal and Influenza Vaccination on Outcomes of Older Adults with Community-Acquired Pneumonia

Authors

  • Adriana Manzur MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Conchita Izquierdo PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Laura Ruiz B Stat,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Dolores Sousa PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Jose-María Bayas PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Jose-Miguel Celorrio PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Wenceslao Varona PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Manel Nebot PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Lluis Salleras PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Angela Domínguez PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • Jordi Carratalà PhD, MD,

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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  • for the Working Group for the Study of Prevention of Community-Acquired Pneumonia in the Elderly

    1. From the *Department of Infectious Diseases, Bellvitge Biomedical Research Institute—Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Health, Generalitat of Catalonia, Barcelona, Spain; Department of Infectious Diseases, Hospital Juan Canalejo, La Coruña, Spain; §Department of Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain; Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud, Spain; #Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain; **Department of Assessment and Intervention Methods. Public Health Agency of Barcelona, Barcelona, Spain; ††Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública, Madrid, Spain; and ‡‡Department of Public Health, University of Barcelona, Barcelona, Spain.
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Address correspondence to Conchita Izquierdo, Department of Health, Generalitat of Catalonia, Roc Boronat 81-95, 08005 Barcelona, Spain. E-mail: conchita.izquierdo@gencat.cat

Abstract

OBJECTIVES: To determine whether prior pneumococcal and seasonal influenza vaccination improves outcomes in older adults hospitalized for community-acquired pneumonia (CAP).

DESIGN: Prospective, observational, multicenter study.

SETTING: Five public hospitals providing universal free care to the whole population in three Spanish regions.

PARTICIPANTS: Individuals aged 65 and older admitted to the hospital with CAP through the emergency department.

MEASUREMENTS: Pneumococcal and influenza vaccination status. The primary study outcomes were intensive care unit (ICU) admission, length of hospital stay (LOS), and overall case-fatality rate. Outcome variables of individuals vaccinated with both vaccines were compared with outcomes of those who were unvaccinated.

RESULTS: Two hundred thirty-eight individuals had received 23-valent pneumococcal polysaccharide vaccine and seasonal influenza vaccination and were compared with 195 unvaccinated individuals. No differences were found with respect to combined antibiotic therapy between groups (38.0% vs 39.7%; P=.80). Similar percentages of vaccinated and unvaccinated individuals required ICU admission (7.2% vs 8.2%; P=.69). Mean LOS was significantly shorter in vaccinated individuals (9.9 vs 12.4 days; P=.04). Overall case-fatality rates were similar in both groups (5.9% vs 5.1%; P=.73). After adjustment, LOS, risk of ICU admission, and overall case-fatality rate were not associated with prior pneumococcal and seasonal influenza vaccination.

CONCLUSION: The clinical outcomes of vaccinated older adults hospitalized with CAP were not better than those observed in unvaccinated individuals.

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