Letter to the Editor
Impact of 13-valent pneumococcal conjugate polysaccharide vaccination on severe exacerbations in patients with chronic obstructive pulmonary disease and established cardiovascular disease

https://doi.org/10.1016/j.ejim.2019.03.010Get rights and content

Highlights

  • Cardiovascular disease in COPD patients not vaccinated with VNC13 and the exacerbator phenotype are related with the need of hospital admission.

  • VNC13 reduces the risk of hospital admission in non-exacerbator phenotype patients with COPD and established cardiovascular disease.

  • The detected benefit may be related to vaccine-induced immunity and its possible cardioprotective effect.

Introduction

Immunocompromised patients with certain underlying diseases, such as chronic obstructive pulmonary disease (COPD) or cardiovascular disease (CVD), are more susceptible to Streptococcus pneumoniae (pneumococcus) infection, characterised by a poor clinical course and severe disease pattern [1,2].

CVDs are the most prevalent comorbidities in patients with COPD and have been related to an increased need for hospitalisation [3], triggered by acute cardiovascular events or decompensated chronic, vascular pathologies. Our group reported that administering the 13-valent pneumococcal conjugate polysaccharide vaccine (VNC13) in patients with COPD seems to reduce the number of exacerbations that require hospital admission [4]. However, the impact of this vaccine on patients with COPD and established CVD has not been evaluated yet.

Section snippets

Materials and methods

To fill this gap, we did a sub-analysis of our former study material [4]. Briefly, a prospective, observational study in 121 patients, followed up for 18 months, was performed. Data had been collected on pulmonary function, body mass index (BMI), dyspnoea measured by the modified Medical Research Council scale (mMRC), pneumococcal vaccination status, number of exacerbations that required hospital admission in that period, as well as comorbidities. Clinical records of the 12 months prior to

Results

Out of 121 patients, 71 (59%) were classified as COPD/CVD. Their baseline characteristics are listed in Table 1. Of the non-vaccinated patients with COPD/CVD, 50% needed hospital admission compared to 16,1% of the vaccinated patients (p = .007). The vaccine-related difference in hospital admission in COPD/-CVD patients was not statistically significant (vaccinated 23% vs. non-vaccinated 13%, p = .413).

Multivariate logistic regression analysis showed that both CVD in non-vaccinated patients as

Discussion

We conclude from this study that vaccination with VNC13 reduces the risk of hospital admission in non-exacerbating patients with COPD/CVD. For the most part, exacerbations in COPD are associated with pathogenic bacteria, such as Haemophilus influenzae, Moraxella catarrhalis, and pneumococcus, the latter being responsible for at least 15% of them [6]. A number of epidemiological studies have shown that pneumococcal infection increases the risk of acute cardiovascular events by two to eight times

Authors' contribution

Juan Marco Figueira Gonçalves: concept and design of the manuscript; data collection, analysis, and interpretation; manuscript drafting, revision, and final approval.

Miguel Ángel García Bello: concept and design of the manuscript; analysis, and interpretation; manuscript drafting, revision, and final approval.

Natalia Bethencourt Martín: data collection; manuscript revision and final approval.

David Díaz Pérez: data collection; manuscript drafting, revision, and final approval.

Lina Inmaculada

Conflict of interest

L.I. Pérez-Méndez was a lecturer in the Research Methodology programme of the Vaccine Academy of Pfizer.

JM Figueira Gonçalves received fees from Pfizer.

Acknowledgement

Manuscript contents have not been submitted to or published previously in any other journal.

All authors have read and given their approval to the final version of the manuscript and declare to have met the requirements for authorship.

All authors have made substantial contributions to the design of this manuscript and assume responsibility for its content.

There was no financial support for drafting this manuscript.

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