Background
Cerebrovascular benefits using the 23-valent pneumococcal polysaccharide vaccine (PPV23)
are controversial. This study assessed clinical effectiveness of PPV23 in preventing
ischemic stroke in people older than 60 years.
Methods
We conducted a population-based cohort study involving 27,204 individuals of 60 years
or older in Tarragona, Spain, who were prospectively followed from December 01, 2008,
until November 30, 2011. Outcomes were neuroimaging-confirmed ischemic stroke, 30-day
mortality from stroke, and all-cause death. Pneumococcal vaccination effectiveness
was evaluated by Cox regression analyses, estimating hazard ratios (HRs) adjusted
for age, sex, comorbidities, and influenza vaccine status.
Results
Cohort members were followed for a total of 76,033 person-years, of which 29,065 were
for vaccinated subjects. Overall, 343 cases of stroke, 45 deaths from stroke, and
2465 all-cause deaths were observed. Pneumococcal vaccination did not alter the risk
of stroke (multivariable HR: 1.04; 95% confidence interval [CI]: .83-1.30; P = .752), death from stroke (HR: 1.14; 95% CI: .61-2.13; P = .686), and all-cause death (HR: .97; 95% CI: .89-1.05; P = .448). In analyses focused on people with and without a history of cerebrovascular
disease, the PPV23 did not emerge effective in preventing any analyzed event, but
influenza vaccine emerged independently associated with a reduced risk of death from
stroke (HR: .51; 95% CI: .28-.93; P = .029) and all-cause death (HR: .73; 95% CI: .67-.81; P < .001).
Conclusions
Our data support that the PPV23 does not provide benefit against ischemic stroke,
but it also supports a beneficial effect of influenza vaccine in reducing specific-
and all-cause mortality risk in the general population older than 60 years.
Key Words
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Article info
Publication history
Published online: March 21, 2014
Accepted:
December 28,
2013
Received in revised form:
November 4,
2013
Received:
August 9,
2013
Footnotes
Grant support: Funding for the study was provided by a grant from the “Fondo de Investigación Sanitaria” of the Instituto de Salud Carlos III (FIS 09/00043) of the Spanish Health Ministry.
This study sponsor had no role in the design or implementation of the study, analysis of data, or reporting of the results.
The work was performed at the Primary Care Service “Camp de Tarragona,” Institut Catala de la Salut, Tarragona, Spain.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.047
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
