Vaccines in COPD

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VACCINATION IN COPDVACCINATION IN COPD
By A.Arputha Selvaraj APMP IIM CalcuttaBy A.Arputha Selvaraj APMP IIM Calcutta

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Approved vaccines for COPDApproved vaccines for COPD
• Vaccines that may confer consistent
benefits in reducing COPD exacerbation
are those directed against
– Influenza and
– Streptococcus pneumoniae
The Proceedings of the American Thoracic Society 3:257-261 (2006)

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Pneumococcal vaccinePneumococcal vaccine
• Recommended for all COPD above 65
years of age
• In COPD < 45 years of age with FEV1 <
40% predicted
GOLD 2006

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• Data regarding the effectiveness of this vaccine
in reducing the incidence of pneumonia or death
(in adults with or without chronic diseases) have
been inconclusive
• Significant efficacy in preventing invasive
pneumococcal disease: OR 0.47 (CI 0.37, 0.59)
corresponding to an efficacy of 53%.

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• A randomized controlled trial in 596 Spanish
patients with COPD over a period of 3 years
• The overall efficacy in preventing CAP by
pneumococcus in all patients was 24%
• The vaccine had an efficacy of
– 76% (95% CI 20 to 93) in patients of <65 years of age
– 48% in those with severe functional obstruction (FEV1
<40%)
– 91% (95% CI 35 to 99) in younger patients (< 65
years) with severe airflow obstruction

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• A prospective cohort study included 11,241
individuals > 65 yrs of age
• The primary outcomes were community-
acquired pneumonia (hospitalized or
outpatient) and death from pneumonia

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• Pneumococcal vaccination did not alter the risk
of hospitalization from pneumonia (Hazard Ratio
: 0.80; 95% confidence interval: 0.50–1.28)
• But the vaccine was associated with
considerable reductions of death risk from
pneumonia (Hazard Ratio: 0.28; 95% CI: 0.09–
0.83)
• Pneumococcal polysaccharide vaccine may not
be effective in reducing the incidence of
pneumonia, but may be able to diminish the
severity of the infection

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• Polyvalent pneumococcal vaccine, contains a mixture of
highly purified capsular polysaccharides from the 23
most prevalent or invasive Streptococcus pneumoniae
• The 23 valent vaccine accounts for at least 90% of
pneumococcal blood isolates
• Each 0.5 ml contains 25 µg of each polysaccharide type
dissolved in isotonic saline solution containing 0.25%
phenol as a preservative.

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Pneumovax 23Pneumovax 23
• Dosage – 0.5 ml IM (Deltoid / lateral mid-thigh)
• Pneumococcal vaccine may be administered at the
same time as influenza vaccine (by separate injection in
the other arm) without an increase in side effects or
decreased antibody response to either vaccine.
• Routine revaccination of COPD persons previously
vaccinated with 23-valent polysaccharide vaccine is not
recommended.
• All persons > 65 years of age who have not received
vaccine within 5 years (and were < 65 years of age at
the time of vaccination) should receive another dose of
vaccine.
• Revaccination following a second dose is not routinely
recommended.
PRODUCT MONOGRAPH, PNEUMO PNEUMOVAX®23,
www.merckfrosst.com

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Adverse effectsAdverse effects
• Hypersensitivity reactions to the
components (Contraindication)
• Arthus-type local reactions especially after
second dose
• Rarely – Lymphadenitis,
thrombocytopenia, Hemolytic anemia,
Hypersensitivity reactions,
Radiculoneuropathy, Guillain-Barré
Syndrome

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Immuno-modulatorsImmuno-modulators
• Oral purified bacterial
extracts improve symptoms
(shortened duration of
exacerbation, reduced risk of
hospitalization) in COPD.
• There is not enough evidence
to suggest that they prevent
exacerbations.
• Cutaneous and urologic
adverse effects are common.
Bronchovaxom & Luivac

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ConcludeConclude
• Pneumococcal vaccine may be beneficial
in selected COPD patients.
• Second dose after 5 years for patients >
65 years of age.

13. Enquiry email : arputhaselvaraj@gmail.com