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BMC Public Health. 2012; 12: 222.
Published online Mar 22, 2012. doi:  10.1186/1471-2458-12-222
PMCID: PMC3331814
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-Corcoles,corresponding author1,2 Olga Ochoa-Gondar,1 Teresa Rodriguez-Blanco,2 Antonia Gutierrez-Perez,2 Angel Vila-Rovira,2 Frederic Gomez,3 Xavier Raga,4 Cinta de Diego,1 Eva Satue,1 and Elisabet Salsench1, EPIVAC Study Group oochoa.tarte.ics@gencat.cat
1Primary Care Service of Tarragona, EPIVAC Study Group, Institut Catalá de la Salut, Tarragona, Spain
2Primary Care Research Institute (IDIAP Jordi Gol) and research associate, Autonomous University of Barcelona (UAB), Barcelona, Spain
3Department of Laboratory and Microbiology, Hospital Joan XXIII, Tarragona, Spain
4Department of Laboratory and Microbiology, Hospital Santa Tecla, Tarragona, Spain
corresponding authorCorresponding author.
Angel Vila-Corcoles: avila.tarte.ics/at/gencat.cat; Olga Ochoa-Gondar: oochoa.tarte.ics/at/gencat.cat; Teresa Rodriguez-Blanco: trodriguez/at/idiapjgol.org; Antonia Gutierrez-Perez: magutierrez.tarte.ics/at/gencat.cat; Angel Vila-Rovira: vilapf/at/gmail.com; Frederic Gomez: ffgomez.hj23.ics/at/gencat.cat; Xavier Raga: xraga/at/xarxatecla.cat; Cinta de Diego: mcdiego.tarte.ics/at/gencat.cat; Eva Satue: esatue.tarte.ics/at/gencat.cat; Elisabet Salsench: esalsench.tarte.ics/at/gencat.cat
Received October 3, 2011; Accepted March 22, 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.
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