Pneumococcal vaccines for children and adults with bronchiectasis
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 methods
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 2007.
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
No randomised controlled trials pertaining effectiveness of pneumococcal vaccine as routine management in children and adults with bronchiectasis were found. 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
At present, there is a lack of reliable evidence to support or refute the routine use of pneumococcal vaccine as routine management in children and adults with bronchiectasis. Randomised controlled trials examining the efficacy of this intervention using various vaccine types in different age groups are needed. Until further evidence is available, it is recommended that health providers adhere to national guidelines.
PICOs
Plain language summary
Pneumococcal vaccines for children and adults with bronchiectasis
In many countries vaccination for the protection against infection of the bacteria pneumococcus, is part of the immunisation schedule for infants as well as, for people with bronchiectasis. In this review, our search for randomised control trials that examined the effectiveness of pneumococcal vaccines for people with bronchiectasis revealed no relevant studies. We thus cannot draw any conclusions for, or against, the routine pneumococcal vaccinations in people with bronchiectasis. However, we would recommend that national guidelines be followed until further evidence is available.
