Influenza and PPSV23 Vaccines Evaluated for Their Ability to Stem COPD Exacerbations

A study published in Respirology found that the trivalent seasonal influenza vaccine (TIV) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) can reduce the risk of hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), pneumonia, and other related illnesses.

In this self-controlled, before-and-after cohort study, all patients were all from Tangshan City of Hebei Province in China and recruited in September 2018. They needed to have been a COPD diagnosis and a postbronchodilator forced expiratory volume in 1 second-to-forced vital capacity ratio of less than 0.702 to be eligible for the study.

Three groups of patients were formed based on the vaccines received: The TIV group received TIV only, the PPSV23 group received PPSV23 only, and the TIV and PPSV23 group received both vaccines. Vaccination started on October 31, 2019, and concluded on November 15, 2019.

There were a total of 474 patients who received at least 1 vaccine for this study: 109 received TIV, 69 received PPSV23, and 296 received both. The median age of the patients was 66 (IQR, 62-70) years. There were 285 patients (60.13%) who were 65 years and older, 78.48% were male participants, and 73.84% were coal miners or former coal miners. COPD degree was mostly moderate or severe.

There were 427 outcome-related events that were reported in the 2-year follow-up period. AECOPD, pneumonia, and hospitalizations accounted for 30.91%; AECOPD and pneumonia, 8.43%; AECOPD and hospitalization, 36.77%; pneumonia and hospitalization, 3.04%; AECOPD, 19.20% only; and pneumonia, 1.64%.

Number of AECOPD, pneumonia, and related hospitalization outcomes before and after vaccination were 58 and 19, 23 and 9, and 39 and 19, respectively, in the TIV group; 59 and 26, 28 and 15, and 35 and 22, respectively, in the PPSV23 group; and 190 and 55, 90 and 23, and 138 and 49, respectively, in the TIV and PPSV23 group.

Incident densities of AECOPD, pneumonia, and related hospitalization decreased by 67.24%, 60.85%, and 51.29%, respectively, in the TIV group; 55.93%, 46.43%, and 37.15% in the PPSV23 group; and 71.05%, 74.45%, and 64.50% in the TIV and PPSV23 group. Incidence density of AECOPD decreased the most.

Incidence densities were greater in patients who were 65 years and older vs patients younger than 65 years. Incident densities were also lower in women.

Vaccine effectiveness for preventing AECOPD, pneumonia, and related hospitalization was 70% (95% CI, 49%-82%), 59% (95% CI, 11%-81%), and 58% (95% CI, 26%-76%), respectively, in the TIV group; 54% (95% CI, 26%-71%), 53% (95% CI, 8%-76%), and 46% (95% CI, 8%-69%) in the PPSV23 group; and 72% (95% CI, 62%-79%), 73% (95% CI, 58%-83%), and 69% (95% CI, 57%-77%) in the TIV and PPSV23 group after adjustment for age, gender, occupation, COPD severity, smoking status, and underlying disease.

Vaccine effectiveness was proven to be more effective outside of the nonpharmaceutical intervention COVID-19 period in AECOPD, pneumonia, and related hospitalization prevention.

There were some limitations in this study. Effectiveness of the vaccines may have been influenced by nonpharmaceutical intervention due to the COVID-19 pandemic and the participants self-chose their group, which may lead to difference in study group composition and could influence the generalizability of the findings.

The researchers concluded that the TIV and PPSV23 vaccines were effective in reducing risk of AECOPD, pneumonia, and related hospitalizations, with AECOPD prevention the greatest success.

“Considering consistency of our results with similar studies, we infer that the effectiveness of both vaccines together is superior to effectiveness of TIV alone and that TIV is more effective than PPSV23 alone,” the authors wrote.

Reference

Li Y, Zhang P, An Z, et al. Effectiveness of influenza and pneumococcal vaccines on chronic obstructive pulmonary disease exacerbations. Respirology. Published online June 15, 2022. doi:10.1111/resp.14309