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A study was undertaken to assess the antibody responses to a 23-valent pneumococcal polysaccharide vaccine and clinical outcome in Taiwanese patients with chronic obstructive pulmonary disease (COPD). Methods: From January to December 1999, 80 Taiwanese patients with COPD were enrolled. Each patient received a 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23). Specific IgG antibodies to pneumococcal capsular antigens of serotypes 4, 6B, 7F, 9V, 14, 18C, 19F, and 23F were measured before vaccination, and 6 weeks and 52 weeks after vaccination. Results: Detectable prevaccination IgG antibody (> 1 mg/mL) was found in the range of 27.5% of patients for serotype 7F to 96.2% for serotype 14. Antibody concentrations in prevaccination sera were not different between middle-aged (< 65 years old) and elderly patients (< 65 years old). The percentage of elderly patients with postvaccination antibody concentration > 2-fold higher than that prior to vaccination ranged from 84% for serotype 18C to 90% for serotypes 7F, 9V, and 19F. The change in antibody level (fold and absolute increases) postvaccination was not significantly different among the different age groups. Conclusion: Taiwanese elderly adults with COPD, even in advanced age, can mount a significant antibody response to pneumococcal polysaccharide vaccine. This study may support the existing recommendation that pneumococcal vaccine be offered to persons ≥ 65 years old with COPD. [J Formos Med Assoc 2007;106(3): 196-203]