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Open Access Research article

Clinical effectiveness of pneumococcal vaccination against acute myocardial infarction and stroke in people over 60 years: the CAPAMIS study, one-year follow-up

Angel Vila-Corcoles12*, Olga Ochoa-Gondar1, Teresa Rodriguez-Blanco2, Antonia Gutierrez-Perez2, Angel Vila-Rovira2, Frederic Gomez3, Xavier Raga4, Cinta de Diego1, Eva Satue1, Elisabet Salsench1 and EPIVAC Study Group1

Author Affiliations

1 Primary Care Service of Tarragona, EPIVAC Study Group, Institut Catalá de la Salut, Tarragona, Spain

2 Primary Care Research Institute (IDIAP Jordi Gol) and research associate, Autonomous University of Barcelona (UAB), Barcelona, Spain

3 Department of Laboratory and Microbiology, Hospital Joan XXIII, Tarragona, Spain

4 Department of Laboratory and Microbiology, Hospital Santa Tecla, Tarragona, Spain

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BMC Public Health 2012, 12:222  doi:10.1186/1471-2458-12-222

Published: 22 March 2012

Abstract

Background

Conflicting results have been recently reported evaluating the relationship between pneumococcal vaccination and the risk of thrombotic vascular events. This study assessed the clinical effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV23) against acute myocardial infarction and ischaemic stroke in older adults.

Methods

Population-based prospective cohort study conducted from December 1, 2008 until November 30, 2009, including all individuals ≥ 60 years-old assigned to nine Primary Care Centres in Tarragona, Spain (N = 27,204 individuals). Primary outcomes were hospitalisation for acute myocardial infarction and/or ischaemic stroke. All cases were validated by checking clinical records. The association between pneumococcal vaccination and the risk of each outcome was evaluated by Multivariable Cox proportional-hazard models (adjusted by age, sex, influenza vaccine status, presence of comorbidities and cardiovascular risk factors).

Results

Cohort members were followed for a total of 26,444 person-years, of which 34% were for vaccinated subjects. Overall incidence rates (per 1000 person-years) were 4.9 for myocardial infarction and 4.6 for ischaemic stroke. In the multivariable analysis, vaccination was associated with a marginally significant 35% lower risk of stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.42-0.99; p = 0.046). We found no evidence for an association between pneumococcal vaccination and reduced risk of myocardial infarction (HR: 0.83; 95% CI: 0.56-1.22; p = 0.347).

Conclusions

Our data supports a benefit of PPV23 against ischaemic stroke among the general population over 60 years, suggesting a possible protective role of pneumococcal vaccination against some acute thrombotic events.