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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.

Enquiry email : arputhaselvaraj@gmail.com