Effectiveness of the 23-valent polysaccharide vaccine against invasive pneumococcal disease in Navajo adults.

Invasive pneumococcal disease occurs 2-3-fold more often among Navajo adults than among adults in the general United States population. The objective of this observational study was to determine the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) among Navajo adults. Active surveillance identified cases of invasive pneumococcal disease during 1996-1997. Three control patients per case patient were matched according to underlying medical conditions, sex, age, and location of medical care. Effectiveness was calculated by regression analysis of case-control sets and by indirect cohort methodology. Diabetes and alcoholism occurred in 41% and 43% of 108 case patients, respectively; 62% of case patients and 64% of control patients were immunized. Overall vaccine effectiveness was 26% (95% confidence interval [CI], -29% to 58%); 15% (95% CI, -116% to 67%) for patients with diabetes and -5% (95% CI, -141% to 54%) for patients with alcoholism. Overall vaccine effectiveness, as determined by use of the indirect cohort methodology, was 35% (95% CI, -33% to 69%). PPV23 was not significantly effective among Navajo adults and may be inadequate to prevent serious pneumococcal disease in this population.

[1]  W. Schaffner,et al.  Rethinking recommendations for use of pneumococcal vaccines in adults. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  A. Schuchat,et al.  Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: Opportunities for prevention in the conjugate vaccine era. , 2001, JAMA.

[3]  A. Schuchat,et al.  Evaluation of effectiveness of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients. , 2000, Archives of internal medicine.

[4]  J. Butler,et al.  Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska, 1991-1998. , 2000, The Journal of infectious diseases.

[5]  D. Briles,et al.  Immunization of healthy adults with a single recombinant pneumococcal surface protein A (PspA) variant stimulates broadly cross-reactive antibodies to heterologous PspA molecules. , 2000, Vaccine.

[6]  E. Lewis,et al.  Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children , 2000, The Pediatric infectious disease journal.

[7]  M. Gentry,et al.  Pneumococcal vaccine response in cirrhosis and liver transplantation. , 2000, The Journal of infectious diseases.

[8]  R. Thompson,et al.  Safety of revaccination with pneumococcal polysaccharide vaccine. , 1999, JAMA.

[9]  L. McDaniel,et al.  A Live Recombinant Avirulent Oral Salmonella Vaccine Expressing Pneumococcal Surface Protein A Induces Protective Responses against Streptococcus pneumoniae , 1998, Infection and Immunity.

[10]  J. Will,et al.  Diabetes mellitus among Navajo Indians: findings from the Navajo Health and Nutrition Survey. , 1997, The Journal of nutrition.

[11]  R. Breiman,et al.  Prevention of pneumococcal disease : recommendations of the Advisory Committee on Immunization Practices (ACIP) , 1997 .

[12]  J. P. Davis,et al.  Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 1997, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[13]  M. Fisch,et al.  Preventing pneumococcal bacteremia in patients at risk. Results of a matched case-control study. , 1995, Archives of internal medicine.

[14]  M. Gentry,et al.  The effect of ethanol ingestion on killing of Streptococcus pneumoniae, Staphylococcus aureus and Staphylococcus epidermidis by rat neutrophils. , 1995, Alcohol and alcoholism.

[15]  A. Lanier,et al.  Immunogenicity of pneumococcal revaccination in patients with chronic disease. , 1994, Archives of internal medicine.

[16]  D. Parks,et al.  Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska 1986-1990. , 1994, The Journal of infectious diseases.

[17]  R. Breiman,et al.  Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. , 1993, JAMA.

[18]  M. Santosham,et al.  High incidence rates of invasive pneumococcal disease in the White Mountain Apache population. , 1992, Archives of internal medicine.

[19]  R. Watson,et al.  Modification of resistance to Streptococcus pneumoniae by dietary ethanol, immunization, and murine retroviral infection. , 1992, Alcoholism, clinical and experimental research.

[20]  R. Adair,et al.  The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. , 1991, The New England journal of medicine.

[21]  L. Preheim,et al.  A model of pneumococcal pneumonia in chronically intoxicated rats. , 1991, The Journal of infectious diseases.

[22]  C. Schraer,et al.  Invasive pneumococcal disease in an Alaska native population, 1980 through 1986. , 1989, JAMA.

[23]  Schwartz Js,et al.  The Clinical Effectiveness of Pneumococcal Vaccine in the Elderly , 1988 .

[24]  K. Lui.  Estimation of sample sizes in case-control studies with multiple controls per case: dichotomous data. , 1988, American journal of epidemiology.

[25]  J. Schwartz,et al.  The clinical effectiveness of pneumococcal vaccine in the elderly. , 1988, Annals of internal medicine.

[26]  D. Jahnigen,et al.  Inefficacy of pneumococcal vaccine in a high-risk population. , 1987, The American journal of medicine.

[27]  E. Shapiro,et al.  A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. , 1984, Annals of internal medicine.

[28]  Y. Vanlaethem.  Pneumococcal polysaccharide vaccine. , 2004, MMWR. Morbidity and mortality weekly report.

[29]  C. Broome,et al.  Pneumococcal Disease after Pneumococcal Vaccination , 1980 .

[30]  J. Moss.  Pneumococcus infection in diabetes mellitus. Is this a justification for immunization? , 1980, JAMA.

[31]  D. V. van Thiel,et al.  Altered immunity in male patients with alcoholic liver disease: evidence for defective immune regulation. , 1980, Alcoholism, clinical and experimental research.

[32]  C. Broome,et al.  Pneumococcal disease after pneumococcal vaccination: an alternative method to estimate the efficacy of pneumococcal vaccine. , 1980, New England Journal of Medicine.

[33]  W. Wood,et al.  STUDIES ON THE EFFECT OF EXPERIMENTAL NONKETOTIC DIABETES MELLITUS ON ANTIBACTERIAL DEFENSE , 1966, The Journal of experimental medicine.

[34]  M. D. Armstrong,et al.  THE PHAGOCYTIC ACTIVITY OF POLYMORPHONUCLEAR LEUKOCYTES OBTAINED FROM PATIENTS WITH DIABETES MELLITUS. , 1964 .

[35]  D. E. Rogers,et al.  THE PHAGOCYTIC ACTIVITY OF POLYMORPHONUCLEAR LEUKOCYTES OBTAINED FROM PATIENTS WITH DIABETES MELLITUS. , 1964, The Journal of laboratory and clinical medicine.

[36]  Perillie Pe,et al.  Studies of the resistance to infection in diabetes mellitus: local exudative cellular response. , 1962 .

[37]  J. Nolan,et al.  Studies of the resistance to infection in diabetes mellitus: local exudative cellular response. , 1962, The Journal of laboratory and clinical medicine.