SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2009
Efficacy of pneumococcal vaccination in adults: a meta-analysis.
Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 139 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
139 citing papers in PubMed, 7 syntheses or guidelines pooled it, 413 citations in OpenAlex.
- Cost Effectiveness of Elderly Pneumococcal Vaccination in Presence of Higher-Valent Pneumococcal Conjugate Childhood Vaccination: Systematic Literature Review with Focus on Methods and Assumptions.PharmacoEconomics · 2019Pooled it
- Pneumococcal Disease and the Effectiveness of the PPV23 Vaccine in Adults: A Two-Stage Bayesian Meta-Analysis of Observational and RCT Reports.Scientific reports · 2018Pooled it
- Pooled it
- Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk--A Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
- The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2013Pooled it
- Comparative effect sizes in randomised trials from less developed and more developed countries: meta-epidemiological assessment.BMJ (Clinical research ed.) · 2013Pooled it
- Vaccines for preventing pneumococcal infection in adults.The Cochrane database of systematic reviews · 2013Pooled it
- Safety and immunogenicity of a single dose 23-valent pneumococcal polysaccharide vaccine in Russian subjects.Human vaccines & immunotherapeutics · 2016Trial
- Open-label trial of immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults ≥ 50 years of age in Mexico.Clinical and vaccine immunology : CVI · 2015Trial
- Randomized controlled study of the safety and immunogenicity of pneumococcal vaccine formulations containing PhtD and detoxified pneumolysin with alum or adjuvant system AS02V in elderly adults.Clinical and vaccine immunology : CVI · 2014Trial
- Trial
- Pneumococcal conjugate and plain polysaccharide vaccines have divergent effects on antigen-specific B cells.The Journal of infectious diseases · 2012Trial
- Cost-utility of pneumococcal strategies for adults aged 50 and older in Colombia: a model-based economic evaluation.BMC health services research · 2026Article
- A narrative review on the effectiveness of PPSV23 vaccination in adults in China.Human vaccines & immunotherapeutics · 2025Review
- A budget impact analysis of 15- or 20- valent pneumococcal conjugate vaccine use in all US adults aged 50-64 years old compared to those with high-risk conditions from US payer perspective.BMC public health · 2025Article
- A novel drug that reduces pneumococcal toxicity by targeting pneumolysin (PLY): efficacy of the traditional Chinese medicineFrontiers in pharmacology · 2025Article
- Glycyrrhetinic acid reduces lung inflammation caused by pneumococcal infection by reducing the toxicity of pneumolysin.Heliyon · 2024Article
- Novel method for production and purification of untagged pneumococcal surface protein A from clade 1.Applied microbiology and biotechnology · 2024Article
- Review
- The remarkable history of pneumococcal vaccination: an ongoing challenge.Pneumonia (Nathan Qld.) · 2022Review
79 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinical trials and meta-analyses have produced conflicting results of the efficacy of unconjugated pneumococcal polysaccharide vaccine in adults. We sought to evaluate the vaccine's efficacy on clinical outcomes as well as the methodologic quality of the trials.
methodsWe searched several databases and all bibliographies of reviews and meta-analyses for clinical trials that compared pneumococcal polysaccharide vaccine with a control. We examined rates of pneumonia and death, taking the methodologic quality of the trials into consideration.
resultsWe included 22 trials involving 101 507 participants: 11 trials reported on presumptive pneumococcal pneumonia, 19 on all-cause pneumonia and 12 on all-cause mortality. The current 23-valent vaccine was used in 8 trials. The relative risk (RR) was 0.64 (95% confidence interval [CI] 0.43-0.96) for presumptive pneumococcal pneumonia and 0.73 (95% CI 0.56-0.94) for all-cause pneumonia. There was significant heterogeneity between the trials reporting on presumptive pneumonia (I(2) = 74%, p < 0.001) and between those reporting on all-cause pneumonia (I(2) = 90%, p < 0.001). The RR for all-cause mortality was 0.97 (95% CI 0.87-1.09), with moderate heterogeneity between trials (I(2) = 44%, p = 0.053). Trial quality, especially regarding double blinding, explained a substantial proportion of the heterogeneity in the trials reporting on presumptive pneumonia and all-cause pneumonia. There was little evidence of vaccine protection in trials of higher methodologic quality (RR 1.20, 95% CI 0.75-1.92, for presumptive pneumonia; and 1.19, 95% CI 0.95-1.49, for all-cause pneumonia in double-blind trials; p for heterogeneity > 0.05). The results for all-cause mortality in double-blind trials were similar to those in all trials combined. There was little evidence of vaccine protection among elderly patients or adults with chronic illness in analyses of all trials (RR 1.04, 95% CI 0.78-1.38, for presumptive pneumococcal pneumonia; 0.89, 95% CI 0.69-1.14, for all-cause pneumonia; and 1.00, 95% CI 0.87-1.14, for all-cause mortality).
interpretationPneumococcal vaccination does not appear to be effective in preventing pneumonia, even in populations for whom the vaccine is currently recommended.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.