Review: pneumococcal vaccination does not prevent pneumonia or death in adults.

O u t c o m e s For RCTs, the outcomes included pneumococcal pneumonia, all-cause pneumonia, pneumonia mortality, and all-cause mortality. M a i n r e s u l t s 15 RCTs met the selection criteria. The trials included 75197 patients, and follow-up ranged from 18 months to 4 years. 3 trials involved older persons, and 3 trials involved patients with chronic disease. The publication date of the trials ranged from 1947 to 1999, with 14 published since 1976, 10 published since 1980, and 3 published since 1990. 7 of 15 trials with a median publication date of 1987 scored ≥ 3 out of 5 for study quality; 8 trials with a median publication date of 1977 scored ≤ 2. Because of significant heterogeneity due to publication year, a random-effects model was used. 14 trials that evaluated all-cause pneumonia had a combined result that appeared to favor pneumococcal vaccines, but this was not statistically significant (Table). 11 trials that evaluated all-cause mortality showed no benefit of vaccination (Table). Results for pneumococcal pneumonia and pneumonia mortality were heterogenous, with more recent trials showing no effect.