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Benin 2003, involving persons aged from 18 years who had a medical condition that placed them at higher risk of pneumococcal disease, or others from age 65 years, found vaccine effectiveness of only 27%.
The inferior estimate of effectiveness among Navajo adults may be due to population char­acteristics.
It was reported that 75% of cases and 78% of controls were assigned as risk level 2 (alcoholism, diabetes, chronic cardiac, lung, renal and liver disease).
This is higher than the equivalent disease risk ratings of the other case-control studies.
Alcoholism in particular is very prevalent in participants in the Benin 2003 study (43% and 45% of cases and controls), which has been associated with poor vaccine immunogenicity (Butler 1993) and **vaccine fail­ures** (Hanna 2000; McMahon 1993).
Both the Jackson 2003 and Vila-Corcoles 2006 cohort studies report very similar multivariate adjusted hazard ratios (HRs) for all-type IPD of0.56 (95% Cl 0.33 to 0.93) and 0.60 (95% Cl 0.22 to 1.65) respectively.
Both studies adjusted for receipt of influenza vaccination.
All-cause pneumonia
All-cause pneumonia was the most reported outcome in this review with data from 16 RCTs.
The pooled estimate of vaccine efficacy was 28% (95% Cl 7% to 44%) but there was substantial variability in the effect estimate due to heterogeneity (I2 = 85%> P < 0.0001).