Response to pneumococcal vaccine in chronic obstructive lung disease—The effect of ongoing, systemic steroid treatment
Introduction
Immunization with pneumococcal vaccine has been recommended for many years for patients with chronic respiratory diseases. The reason for this has mainly been the fact that pneumococci are the most frequent bacteria in exacerbation in patients with chronic obstructive lung disease (COPD) [1], although it may not influence the risk of pneumonia, but only the risk of invasive disease [2]. The benefit of the procedure has recently been questioned based on a meta-analysis [3], but this question has not been finally answered yet, as conclusions are jeopardized by few patients included, and difficulty in the measurements of the patient-benefits.
In children after splenectomy the vaccination-response was normal if doses of prednisolone was below 1.5 mg/kg/day, but weakened if larger [4]. In patients with nephrotic syndrome, steroids did not influence the vaccination-response [5] as in patients with steroid-dependent asthma [6]. Patients with chronic obstructive lung disease have not been investigated.
We wanted to investigate if ongoing treatment with systemic steroids hampered the immune response after a vaccination with 23-polyvalent pneumococcal vaccine. Our clinical problem was if we should vaccinate the patient at entrance in the hospital, or wait until the treatment with systemic steroids has stopped.
Section snippets
Materials and methods
Forty-nine patients with COPD were included and block-randomized to vaccination or not. COPD was defined according to the GOLD-guideline [7], i.e., FEV1/FVC <70%, FEV1 reversibility-test <200 ml.
The grouping was chosen to simulate the different clinical problems in relation to systemic treatment with steroids and timing of vaccination. Randomization was carried out by means of closed and non-transparent envelopes marked with group no. 2 (ongoing steroid treatment) or group nos. 1/4 (no steroids
Antibodies
Every patient had antibodies present at entrance in the study with no difference in the median and summarized antibody levels between groups (Table 3). Only patients vaccinated and then treated with systemic steroids showed a significant rise in titres, when all serotypes were considered together (group 1). In the vaccinated groups (Table 4) the majority of the patients experienced a rise and later a fall in titres, whereas two of the unvaccinated control patients had a slight development in
Discussion
Pneumococcal infection is the most frequent cause of bacterial pneumonia acquired outside hospitals, and patients older than 65 years carries a higher risk of invasive disease. Accordingly, there is a higher mortality in the older age groups. A beneficial effect of vaccination has been shown in Stockholm [3], [10] in patients older than 65 years concerning hospital admissions with pneumonia, invasive pneumococcal disease and mortality. Nichol et al. [2] documented a lower rate of hospital
Acknowledgements
The study has been supported by grants from: Boehringer Ingelheim Denmark and The Medical Association of Storstroem County. None of the participants had any financial connections to sponsors or any other commercial company involved.
References (14)
- et al.
Airway infection
Infect Dis Clin North Am
(1998) - et al.
A modified enzyme-linked immunosorbent assay for measuring type-specific anti-pneumococcal capsular polysaccharide antibodies
J Immunol Methods
(1993) - et al.
Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study
Lancet
(2001) - et al.
Pneumococcal infection and immunologic response to pneumococcal vaccine in chronic obstructive pulmonary disease. A pilot study
Chest
(1987) - et al.
The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease
Arch Intern Med
(1999) - et al.
Is polysaccharide pneumococcal vaccine effective in adults?
Ugeskr Laeger
(2001) Antibody response to pneumococcal vaccine in splectomized children
Acta Pathol Microbiol Scand Sect C
(1983)