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PubMed2005

Creating and validating a pneumococcal vaccination registry.

Healthy People 2010 set a goal of 90% vaccination rate for pneumococcal vaccine in elderly patients. We developed a keyword search, using pharmacy orders for Pneumovax as a gold standard, to determine patient eligibility for a computerized pneumococcal vaccination registry. The keyword search captured 98% of vaccinations in the validation dataset. A total of 4,768 patients matched at least one keyword in the search and were added to the immunization registry. Through our search, we found a 63% vaccination rate in the primary care patient population older than 65, leaving 37% of the high risk population still needing vaccinations.

Aged↗
PubMed1988

The effect of pneumococcal vaccine on the disposition of theophylline.

Pneumococcal vaccine is frequently given to chronic obstructive airway disease patients who are maintained on theophylline therapy. Several studies demonstrating the effect of viral and bacterial vaccines on drug metabolism prompted our evaluation of the effect of pneumococcal vaccine on theophylline pharmacokinetics. Six healthy volunteers, acting as their own controls, received 250 mg of theophylline every 8 h for 12 days. Plasma area under the concentration-time curves (AUC) were measured on Days 4, 6, and 12. On Day 5 pneumococcal vaccine (0.5 ml) was given intramuscularly. No significant difference in elimination rate constant, AUC, or apparent oral clearance of theophylline was found at one or seven days after vaccine administration. These results indicate that intramuscular pneumococcal vaccine does not alter the pharmacokinetics of theophylline during chronic oral administration.

Adult↗
PubMed2002

Influenza and pneumococcal vaccination in Scottish nursing homes: coverage, policies and reasons for receipt and non-receipt of vaccine.

A national survey was carried out to determine the coverage of influenza and pneumococcal vaccines, policies, reasons for receipt, non-receipt of vaccine and strategies to improve vaccine coverage in Scottish nursing homes. Of the 550 nursing homes, 72% (394) participated in the study. Overall coverage was 85% for influenza vaccine in 2001-2002 season and 11% for pneumococcal vaccine in the last 5-year period. Only 6% (23/394) of homes were reported to have a systematic immunization record. The most frequently stated reasons for improved coverage of both vaccines were clear immunization policies (76%), awareness and education for staff and residents (68%), and consent on behalf of the incompetent residents (66%). The presence of vaccination policies was higher for influenza vaccine than pneumococcal vaccine expressed as verbal agreement (27% versus 3%), written policies with set target (24% versus 5%) and written policies without set target (17% versus 2%). Advice from the members of the community health care team was the principal reason for the receipt of both vaccines. The predominant reasons for non-receipt of vaccine were refusal by residents and family members (both vaccines) and lack of advice from general practitioners (pneumococcal vaccine). The substantial disparity in coverage of influenza and pneumococcal vaccine reflects the lack of national recommendations and policies for reimbursements for pneumococcal vaccination. These data suggest that greater efforts are needed to improve prevention behaviors of health care professionals and the public, organized vaccine delivery strategies and systematic vaccination documents to increase influenza and pneumococcal vaccination rates in nursing homes and other long-term care facilities.

Bacterial Vaccines↗
PubMed1994

Barriers to immunization--an examination of factors that influence the application of pneumococcal vaccine by house staff.

Pneumococcal infection is a leading cause of adult morbidity and mortality in the United States. Immunization against this infection is a valuable strategy in preventive medicine. An effective pneumococcal vaccine has been available in this country for over a decade, but it remains poorly utilized. The purpose of the present investigation was to analyse the factors that affect the use and administration of the pneumococcal vaccine and to identify barriers to use. Upper-level internal medicine residents (n = 33) from two medical clinics associated with an academic medical centre completed an explanatory survey. This explored the levels of house-staff knowledge, perception and attitudes regarding the vaccine and the existence of practical barriers against its utilization. chi 2 analyses and z tests were carried out to determine significance, where appropriate. The majority of the house staff (22, 66.7%) answered correctly regarding vaccine target groups, and all residents indicated that they generally obtain a vaccination history in adult patient evaluation. However, a sizeable number (14, 42.4%) did not indicate a time of the year when they routinely administered vaccines to patients. They were not confident about their knowledge regarding vaccine guidelines (23, 69.7%) and had an exaggerated fear of hypersensitivity reactions from immunization (20, 60.6%). Neither the expense of the vaccine nor adverse publicity were impediments to immunization (24, 72.7% and 28, 84.8%, respectively). Although most physicians knew of the usefulness of the vaccine (31, 93.9%), many failed to translate this knowledge into clinical practice (22, 66.7%). 'Pressing' clinical issues were viewed as barriers to vaccination (18, 54.5%) and placed the practice of preventive medicine in a subordinate position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Use of a low-literacy patient education tool to enhance pneumococcal vaccination rates. A randomized controlled trial.

CONTEXT: Pneumococcal immunization rates for elderly and high-risk patients are only one third to one half the target rate of 60% established by the US Public Health Service. Limited or marginal literacy, which affects nearly 100 million Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE: To determine whether the use of a simple, low-literacy educational tool enhances patient-physician dialogue about pneumococcal vaccination and increases rates of immunization. DESIGN: A randomized controlled trial conducted between May and June of 1998. SETTING: Ambulatory care clinic of a 900-bed public teaching hospital serving a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS: Of 433 patients who presented for routine primary care, had vaccine indications (age > or =65 years or chronic disease), and had not been previously vaccinated, 221 were randomly assigned to the intervention group and 212 to the control group. Of the total patient population (mean age, 63 years), 280 (64.7%) had less than a high school education, 401 (92.6%) were African American, and 300 (69.3%) were female. INTERVENTION: One-page, low-literacy (below fifth-grade level) educational handout encouraging patients to "ask your doctor about the pneumonia shot" vs a control group (1 -page, low-literacy educational handout conveying information about nutrition). MAIN OUTCOME MEASURES: Vaccination rates (documented by chart audit) of patients who received pneumococcal vaccination and rates of patients who self-reported having discussed vaccination with their physicians. RESULTS: Patients in the intervention group were 4 times more likely to have discussed the pneumococcal vaccine with their physicians than patients in the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97 [95% confidence interval [CI], 2.71-5.83]), and were more than 5 times as likely to have received the pneumococcal vaccine than the control group (44/221 [19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate analysis controlling for race, sex, education, insurance status, age, level of physician training, health status, and vaccine indication, only assignment to the intervention group was statistically significantly related to the probability of being immunized or discussing the issue with their physicians (P<.001 for both trends). CONCLUSIONS: A simple, low-literacy educational tool increased pneumococcal vaccination rates and patient-physician discussions about the vaccine in an elderly, low-literate, indigent, minority population.

Aged↗
PubMed2004

Pneumococcal vaccination for the elderly in The Netherlands? Assessment of the quality and content of available comparative studies.

BACKGROUND: A question that is currently topical in the Netherlands is whether it makes sense to introduce on a national scale vaccination against pneumococcal infections for elderly people who are at present receiving the influenza vaccination. We recently studied the scientific literature on the subject in an attempt to answer this question. METHODS: We searched for systematic reviews (SRs), randomised clinical trials (RCTs) and cohort studies in MEDLINE, EMBASE, the Cochrane Library, Current Controlled Trials and via Google (period 1966 to June 2002). The SRs and RCTs were assessed with a methodological checklist. RESULTS: We identified four SRs, two trials (of which one was pseudo-random) and one retrospective cohort study. The methodological quality of the SRs was reasonable and in this respect differed little among themselves. The SRs differed strongly with regard to subgroups, outcome measures, valency of vaccines, duration of follow-up and combination with influenza vaccination. The SRs showed that vaccination has more effect in low-risk groups, does not appear to be effective in high-risk patients and the elderly and is more effective in nonindustrialised countries. The outcomes based on the various outcome measures showed major differences. The three studies into the effectiveness of the pneumococcal vaccination in the elderly all showed major methodological shortcomings. For the majority of outcome measures the outcomes were negative. CONCLUSION: There is insufficient convincing evidence in favour of the introduction of the pneumococcal vaccination as a supplement to influenza vaccination for the elderly. It seems as if (international) opinion had already been fully formed before published studies and systematic reviews become available in the last few years. It is perhaps worth considering setting up a prospective trial in the elderly Dutch population.

Aged↗
PubMed2002

Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001.

Two vaccine-preventable diseases, influenza and pneumococcal disease, contribute to the mortality of older persons in the United States. Influenza caused an average of 20,000 deaths per year during influenza epidemics in the United States from 1969 to 1996; persons aged > or = 65 years accounted for approximately 90% of these deaths. Pneumococcal disease caused approximately 3,400 deaths among persons aged > or = 65 years in the United States in 1998. National health objectives for 2010 include increasing influenza and pneumococcal vaccination levels to > or = 90% among persons aged > or = 65 years (objective nos. 14.29a and 14.29b, respectively). To assess progress toward achieving these objectives, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results, which indicate that the estimated point prevalences of influenza and pneumococcal vaccination were <80% among persons aged > or = 65 years in all reporting areas. Influenza vaccination levels during 2000-2001 decreased from 1998-1999 levels in 27 of 52 reporting areas; pneumococcal vaccination prevalence increased a median of 7 percentage points from 1999 to 2001. Continued efforts are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.

Aged↗
PubMed2004

Recent advances in pneumococcal vaccination of children.

Pneumococcal disease is a major cause of childhood morbidity and mortality worldwide. However, there is a lack of epidemiological data to describe the vaccine-preventable burden of disease. New pneumococcal conjugate vaccines offer hope of preventing infant pneumococcal disease. The efficacy of the 7- and 9-valent pneumococcal conjugate vaccine (PCV) against invasive vaccine-type pneumococcal disease in young children is between 77 and 97%. The PCV vaccine efficacy against radiological pneumonia in HIV-negative infants for the 7- or 9-valent PCV is 23-30%. The vaccine efficacy in HIV-positive infants is lower--65% against invasive vaccine-type pneumococcal disease and no significant efficacy against radiological pneumonia. The 7-valent PCV showed modest efficacy against acute otitis media (7%) but seems to be more effective in preventing recurrent or severe disease. The high cost of these new vaccines is a barrier to their widespread introduction. The development of other pneumococcal vaccine candidates with wider serotype coverage should be encouraged. These vaccines should be affordable for all countries, particularly those with the highest burden of disease. In addition, other vaccination strategies such as maternal and neonatal immunisation and combinations of fewer doses of the PCV combined with an early dose of the cheaper pneumococcal polysaccharide vaccine need to be assessed further.

Child↗
PubMedDate not supplied

[7-valent conjugate Pneumococcal vaccine and nasopharyngeal cavity].

7-valent conjugate pneumococcal vaccine is effective for preventing invasive pneumococcal diseases in childhood. The present serotype formulation of the conjugate Pneumococcal Vaccine is effective for preventing 75-90% of the invasive pneumococcal disease cases, depending of the vaccine-serotypes distribution in the several countries. Recent studies, carried out in the north-american context, show that mass vaccination campaign by 7-valent conjugate Pneumococcal Vaccine in childhood, reduce, in vaccinated subjects, the nasopharyngeal colonization by vaccine-serotypes, that are much more joined to antibacterial resistance. This implies non only an active and specific protection for vaccinated, but also for family and community contacts, children and adults. This interesting results, need to be confirmed also in european countries, open a new view for a wider pharmacoeconomic evaluation of the 7-valent conjugate Pneumococcal Vaccine in childhood.

Child↗
PubMed1980

Severe local reactions to pneumococcal vaccine.

Two patients who received pneumococcal vaccine had severe pain and swelling that extended beyond the site of injection. Both patients were atopic, and each had either received pneumococcal vaccine in the past or had had extensive laboratory contact with pneumococci. Care must be exercised in selecting patients for revaccination with pneumococcal vaccines.

Adult↗
PubMed1984

C-polysaccharide in a pneumococcal vaccine.

The 14-valent pneumococcal vaccine, Pneumovax, was found to contain approximately 25o micrograms per ml of the cell-wall antigen, C-polysaccharide (C-Ps), in addition to 100 micrograms per ml of each of the 14 capsular polysaccharides. Rabbit anti-C-Ps antiserum recognized four components of this C-Ps with different antigenic determinants, corresponding to four fragments with different molecular sizes. By lectin affinity chromatography it was demonstrated that some of the C-Ps in the vaccine contained cell-wall residues. The methods used in this study can also be used for the characterization of other polysaccharide preparations.

Antigens, Bacterial↗
PubMed1998

[Pneumococcal vaccination--yes or no?].

Invasive pneumococcal infections, defined as demonstration of Streptococcus pneumoniae in blood cultures or CSF, are frequent and associated with high mortality in risk groups. Risk groups are the over-65s, individuals with anatomic or functional asplenia, immunosuppressed patients, patients with haemotological neoplasias and HIV-infected subjects, as well as, in general, al sufferers from chronic cardiopulmonary disease, diabetics and patients with severe renal failure or nephrotic syndrome. The 23valent polysaccharide vaccine produces a reliable immune response in children aged over 2 years and adults. The immune response is diminished in severely immunocompromised subjects and in the elderly. Numerous clinical studies provide evidence of the effectiveness of pneumococcal vaccination in the he prevention of invasive pneumococcal infection. Pneumococcal vaccination is recommended for the above mentioned risk groups. It should be observed that for the group at most risk, i.e. heavily immunosuppressed and HIV-infected subjects, there are no convincing data on clinical effectiveness. Regarding non-bacteriaemic pneumococcal pneumonias there are only pointers to the possible usefulness of polysaccharide vaccines. Booster vaccination is not recommended by the manufacturers in view of the reportedly increased incidence of side effects. Studies show that side effects are not more frequent than with primary vaccination. A single revaccination is particularly indicated in status post splenectomy. The conjugate vaccines now under development will improve the efficacy of pneumococcal vaccination and will also be usable in children aged under 2 years.

Adolescent↗
PubMed2005

[Understanding of pneumococcal vaccination in patients with chronic respiratory diseases].

Pneumococcal vaccination is still rare in Japan. To evaluate understanding concerning the vaccination, we employed a questionnaire answered by patients aged over 60 with chronic respiratory diseases from August to October 2002. Only 286 (18%) of the 1595 patients already knew of the existence of the vaccine, and 999 (64%) patients wanted to be vaccinated. That season, 717 (43%) patients were actually vaccinated. Patients with chronic respiratory failure, those who had contracted pulmonary infections in the previous year, those over 70 year-old, and male patients tended to be vaccinated. Although elderly and high-risk patients are recommended to be vaccinated, the pneumococcal vaccination rates in those patients was low. Campaigns for vaccination are needed.

Aged↗
PubMedDate not supplied

[Efficacy of pneumococcal vaccine in military units].

Pneumococcal vaccine Pneumo-23, used for specific prophylaxis of pneumonia and other pneumococcal infections, was tested in military training units of the North Western, Central and Far Eastern Military Districts. The vaccine used for immunization of servicemen, was shown to have high immunogenicity with no adverse reactions. In the training group of the North Western Military District the epidemiological effectiveness of the vaccine was particularly high a month after immunization and amounted to 83.7%. During the period between month 2 and month 5 after immunization pneumonia morbidity among the immunized servicemen was 6.12 times lower than among the non-immunized ones. In the training units of the Central and Far Eastern Military Districts, where the period of the formation of postvaccinal immunity coincided with the peak of the outbreak of pneumonia, the protective properties of the used batches of the vaccine could be observed as early as during the first month after immunization, which made it possible to recommend this vaccine for urgent prophylaxis in the foci of pneumococcal infection. During the period of 5 months the effectiveness of the vaccine with respect to pneumonia was 62.1-66.2% for all three districts. The effectiveness of the combined immunization of conscripts with vaccines Pneumo-23 and Vaxigrip with respect to pneumonia was higher (78.54%) and the index of effectiveness (4.66) was 1.58 fold greater than in monoimmunization (2.95). The epidemiological effectiveness of the pneumococcal vaccine was high also with respect to other pneumococcal infections: acute bronchitis, acute respiratory diseases of pneumococcal etiology, cases of acute sinusitis and acute otitis. The use of the vaccine for the immunization of servicemen yielded the economic effect equal to 92 US dollars per person.

Disease Outbreaks↗
PubMed1986

Revaccination of renal transplant and hemodialysis recipients with pneumococcal vaccine.

Two years after pneumococcal vaccine was given to patients on a university renal transplant and hemodialysis service, vaccine failures began to occur. Serologic studies showed a threefold decrease in antibody levels during this period, from 913 ng of antibody nitrogen per milliliter to 315 ng/mL. The decrease was greater in patients undergoing hemodialysis than in renal transplant recipients (879 to 215 ng/mL vs 932 to 385 ng/mL). The lowest antibody levels were to types 4, 6A, and 19F. Patients were revaccinated, without serious reactions, and pneumococcal infections decreased as they had after the original vaccination program. After revaccination, there was a twofold increase in antibody levels (315 to 602 ng/mL), but the levels did not reach those seen after primary vaccination. The increase was greater in hemodialysis than in renal transplant recipients (215 to 757 ng/mL vs 385 to 536 ng/mL). This experience indicates that pneumococcal vaccines may be effective in patients undergoing hemodialysis and in asplenic renal transplant recipients, but these groups will require revaccination sooner than normal subjects to maintain immunity.

Antibodies, Bacterial↗
PubMed2005

An economic analysis of a pneumococcal vaccine programme in people aged over 64 years in a developed country setting.

BACKGROUND: Polysaccharide pneumococcal vaccination for older adults is being introduced in developed country settings. Evidence of protection by this vaccine against pneumococcal pneumonia, or confirmation that illness and death from bacteraemia are prevented, is currently limited. Decisions are often made based on partial information. We examined the policy implications by exploring the potential economic benefit to society and the health sector of pneumococcal vaccination in older adults. METHODS: A model to estimate the potential cost savings and cost-effectiveness of a polysaccharide pneumococcal vaccine programme was based on costs collected from patients, the literature, and routine health-services data. The effect of a pneumococcal vaccine (compared with no vaccination) was examined in a hypothetical cohort aged over 64 years. The duration of protection was assumed to be 10 years, with or without a booster at 5 years. RESULTS: If it were effective against morbidity from pneumococcal pneumonia, the main burden from pneumococcal disease, the vaccine could be cost-neutral to society or the health sector at low efficacy (28 and 37.5%, respectively, without boosting and with 70% coverage). If it were effective against morbidity from bacteraemia only, the vaccine's efficacy would need to be 75 and 89%, respectively. If protection against both morbidity and mortality from pneumococcal bacteraemia was 50%, the net cost to society would be 2500 pounds per year of life saved ( 3365 pounds from the health-sector perspective). Results were sensitive to incidence, case-fatality rates, and costs of illness. CONCLUSIONS: A vaccine with moderate efficacy against bacteraemic illness and death would be cost-effective. If it also protected against pneumonia, it would be cost-effective even if its efficacy were low.

Aged↗
PubMed1994

Antibody response to influenza, tetanus and pneumococcal vaccines in HIV-seropositive individuals in relation to the number of CD4+ lymphocytes.

OBJECTIVE: To establish when the formation of antibodies against T-lymphocyte-dependent and -independent antigens is impaired during HIV infection. DESIGN: Prospective study on antibody formation before and 30 days and 60 days after vaccination with tetravalent influenza vaccine, tetanus toxoid and pneumococcal vaccine; booster with influenza vaccine was administered 30 days after initial vaccination. SETTING: Outpatient clinic of University Hospital Leiden. PARTICIPANTS: Fifty-one HIV-infected individuals and 10 healthy controls. RESULTS: In HIV-infected individuals with < 100 x 10(6)/l CD4+ lymphocytes almost no influenza antibodies were formed; CD4+ counts between 100 and 300 x 10(6)/l correlated with suboptimal antibody formation; CD4+ counts > or = 300 x 10(6)/l yielded more individuals with protective antibody titres. Thirty days after vaccination, protective antibody titres against the four influenza strains had been achieved in 24% of all HIV-infected individuals for A/Beijing (H3N2) (controls, 90%), 59% for A/Taiwan (H1N1) (controls, 80%), 18% for B/Beijing (controls, 30%) and 37% for B/Panama (controls 90%). Booster vaccination after 1 month did not increase antibody levels. Anti-tetanus toxin antibody formation, which is also T-lymphocyte-dependent, was correlated with the number of CD4+ lymphocytes. After pneumococcal vaccination (T-lymphocyte-independent), normal antibody formation was observed in HIV-infected individuals, including those with low CD4+ counts. CONCLUSIONS: Influenza vaccination should not be administered to HIV-infected individuals with CD4+ counts < 100 x 10(6)/l; pneumococcal vaccination can be offered to all HIV-infected individuals and a tetanus toxoid booster should be administered when indicated.

Adult↗
PubMed1999

Determination of antibody responses of elderly adults to all 23 capsular polysaccharides after pneumococcal vaccination.

The 23-valent pneumococcal polysaccharide vaccine was formulated to prevent invasive infection in the elderly and other high-risk populations from the most prevalent Streptococcus pneumoniae serotypes. However, the immunogenicity of all 23 vaccine polysaccharides has not been fully characterized in elderly adults. We previously reported that whereas the majority of elderly subjects had vigorous immune responses to selected pneumococcal vaccine polysaccharides, a subset of elderly individuals responded to fewer than two of seven vaccine serotypes after immunization. To determine whether these elderly low responders have a general inability to respond to pneumococcal vaccine and to determine whether elderly low responders might be identified by their responses to a few polysaccharides, we measured antibody responses of elderly adults to all 23 vaccine polysaccharides after pneumococcal immunization. As a group, elderly subjects showed a significant rise after immunization in geometric mean antibody levels to all 23 vaccine serotypes. However, when individual rather than group immune responses were assessed, the 23-valent vaccine did not appear to be uniformly immunogenic in these elderly subjects. Eleven elderly subjects (20%) had twofold increases in specific antibody after vaccination to only 5 or fewer of the 23 vaccine polysaccharides, and they did not respond to the most prevalent serotypes causing invasive disease. Antibody responses to serotype 9N were found to reliably distinguish low vaccine responders from other elderly subjects. However, no particular group of vaccine polysaccharides could be used as a marker for adequate immune responses if only postvaccination sera were analyzed.

Aged↗