Pneumococcal and influenza vaccination: current situation and future prospects.

Background: The effectiveness of influenza and pneumococcal vaccination in the prevention of hospital admissions and death has not been assessed prospectively. We have therefore examined the effects of influenza and pneumococcal vaccination in individuals aged 65 years or older in a 3-year prospective study, between December 1 1998 and May 31 1999. Methods: All individuals in Stockholm County aged 65 years or older (259 627) were invited to take part in a vaccination campaign against influenza and pneumococcal infection. We recorded for all vaccine recipients (100 242) name and date of birth, and whether they had been given both or one of the vaccines. All individuals (>65 years) admitted to hospital in Stockholm County with influenza and pneumonia related diagnoses were identified between December 1 1998 and May 31 1999. Findings: The incidence (per 100 000 inhabitants per year) of hospital treatment was lower in the vaccinated than in the unvaccinated cohort for all diagnoses: 263 versus 484 (–46% (95% CI 34–56)) for influenza; 2199 versus 3097 (–29% (24–34)) for pneumonia; 64 versus 100 (–36% (3–58)) for pneumococcal pneumonia, and 20 versus 40 (–52% (1–77)) for invasive pneumococcal disease. The total mortality was 57% (55–60) lower in vaccinated than in unvaccinated individuals (15.1 vs 34.7 deaths per 1000 inhabitants). Interpretation: These findings show that general vaccination leads to substantial health benefits and to a reduction of mortality from all causes in this age group. (Lancet 2001;357:1008–11)