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Pneumococcal vaccines for children and adults with bronchiectasis (Review)

Chang, Christina C., Singleton, Rosalyn J., Morris, Peter S. and Chang, Anne B. (2007). Pneumococcal vaccines for children and adults with bronchiectasis (Review). Cochrane Database of Systematic Reviews,2007(2 - Article No. CD006316).

Document type: Journal Article
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Title Pneumococcal vaccines for children and adults with bronchiectasis (Review)
Author Chang, Christina C.
Singleton, Rosalyn J.
Morris, Peter S.
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2007
Volume Number 2007
Issue Number 2 - Article No. CD006316
ISSN 1469-493X   (check CDU catalogue open catalogue search in new window)
Total Pages 13
Place of Publication United Kingdom
Publisher John Wiley & Sons Ltd.
HERDC Category C1 - Journal Article (DEST)
Abstract Background
Bronchiectasis is increasingly recognized as a major cause of respiratory morbidity especially in developing countries. Even in affluent countries, bronchiectasis is increasingly seen in some community subsections (e.g. Aboriginal communities) and occurs as a comorbidity and disease modifier in respiratory diseases such as chronic obstructive pulmonary disease (COPD). Respiratory exacerbations in people with bronchiectasis are associated with reduced quality of life, accelerated pulmonary decline, hospitalisation and even death. Conjugate pneumococcal vaccine is part of the routine infant immunisation schedule in many countries. Current recommendations for additional pneumococcal vaccination include children and adults with chronic suppurative disease.

Objectives
To evaluate the effectiveness of pneumococcal vaccine as routine management in children and adults with bronchiectasis in (a) reducing the severity and frequency of respiratory exacerbations and (b) pulmonary decline.

Search strategy
The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. Pharmaceutical manufacturers of pneumococcal vaccines were also contacted. The latest searches were performed in November 2008.

Selection criteria
All randomised controlled trials that utilised pneumococcal vaccine on children and adults with bronchiectasis. All types of pneumococcal vaccines were included.

Data collection and analysis
Results of searches were reviewed against pre-determined criteria for inclusion. No eligible trials were identified and thus no data was available for analysis. One small non-randomised controlled trial in children was reported.

Main results
One randomised controlled open label study in 167 adults with chronic lung disease (bronchiectasis and other diseases associated with bronchiectasis) compared 23-valent pneumococcal (PV) and influenza vaccine with influenza vaccine alone (control group). The study found a significant reduction in acute infective respiratory exacerbations in the PV group compared to the control group, OR=0.48 (95%CI 0.26, 0.88); number needed to treat to benefit = 6 (95%CI 4, 32) over 2-years. There was however no difference in episodes of pneumonia between groups and no data on pulmonary decline was available. In another study, a benefit in elimination of Strep. pneumoniae in the sputum was found in a non-randomised trial in children but no clinical effect was described.

Authors' conclusions
Current but limited evidence support the use of 23-valent pneumococcal vaccine as routine management in adults with bronchiectasis. Circumstantial evidence also support the use of routine 23-valent pneumococcal vaccination in children with bronchiectasis. Further randomised controlled trials examining the efficacy of this intervention using various vaccine types in different age groups are needed. There is no data on the efficacy of pneumococcal vaccine on pulmonary decline. With the lack of evidence in how often the vaccine should be given, it is recommended that health providers adhere to national guidelines.
DOI http://dx.doi.org/10.1002/14651858.CD006316.pub2   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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