Over the past 15 years, no fewer than ten meta-analyses or systematic literature reviews of the efficacy of
pneumococcal polysaccharide vaccine in adults have been conducted, including one specifically in
chronic obstructive pulmonary disease patients. Their general conclusion is that it is effective in preventing invasive
infections, but no conclusions can be drawn for high-risk patients (owing to a highly polymorphic population). Opinions are divided as to its efficacy in
pneumonia, with the studies being too heterogeneous to carry sufficient statistical weight. Most conclude that there is no impact on mortality.
Chronic obstructive pulmonary disease patients are frequently described as an at-risk population, but controlled studies in such patients are very limited, leaving only case-control or cohort studies to provide information on which to base any decision. The aim of this article is first to discuss the place of pneumococcal
polysaccharide vaccination in this risk population, which is increasing in prevalence and in which
pneumococcal infections play a considerable role. Pending other
vaccines, the
polysaccharide vaccine is currently the only preventive approach that has demonstrated an effect, even if it does not match up to expectations. The possibilities of alternative
vaccines, such as
conjugate vaccines in the near future and perhaps
protein vaccines at a later date, will be considered.