Pneumococcal Vaccination among Adults with Respiratory Diseases-Indications, Adherence and Roadblocks

Abstract

Introduction: Globally, invasive pneumococcal disease poses a major challenge to the health system and causes significant economic burden. Pneumococcal vaccination is a recommended and well adhered practice among paediatric age groups as opposed to adult population, where it is often overlooked or ignored. CDC recommends pneumococcal vaccination in all subjects more than 65 years. In subjects less than 65 years, those with certain associated medical conditions are targets to pneumococcal vaccination strategy. Aim: To evaluate the indications for pneumococcal vaccination in adult subjects admitted with respiratory diseases to a tertiary care facility, as well as to examine the adherence to pneumococcal vaccination protocols. In those who were not vaccinated as per guidelines, to determine the reasons for noncompliance to vaccination guidelines. Materials and Methods: This was a retrospective observational study, which was carried out in the pulmonary medicine unit of a tertiary care hospital in Kerala, Southern India. Subjects admitted to the respiratory unit with various diseases over a three month period from January 2018 to March 2018 were included in the study. The demographic data, primary disease and medical comorbidities were noted. The indications to pneumococcal vaccination as per the CDC recommendations were evaluated. The actual subjects who underwent vaccine administration were noted down and reasons for non-compliance were recorded. The collected data were analysed using descriptive statistical methods, in which categorical variables were expressed as frequency and percentage, and continuous variables were analysed using mean and standard deviation with the Word excel software. Results: A total of 284 patients were admitted to the respiratory unit in the study period due to varying primary respiratory diseases and comorbidities. Of these 268 patients were eligible for pneumococcal vaccination as per CDC criteria. Of these 268 patients 216 patients (80.59%) were vaccinated with either PPV or PCV depending on patient preference. A total of 52 patients were not vaccinated (19.4%). The reason for non-adherence to vaccination in these patients was variable. Sixteen patients (30.77%) received vaccination from another health care centre outside our hospital prior to admission. Three patients (5.77%) were transferred to another department for further care, but vaccination was not done at either units. A total of 26 patients (50%) with suspected Obstructive Sleep Apnea (OSA), who were admitted for overnight polysomnography, were not given vaccination although all of them had indications. One patient expired and two patients (3.84%) refused due to social reasons. Active counselling and vaccine recommendation was found to be missing in the case records of four patients, (7.69%) probably due to overlooking on the part of medical team. Conclusion: A pneumococcal vaccination adherence rate of 81% was noted in the present study. Indications for pneumococcal vaccination were overlooked in a sizeable inpatient population being admitted for overnight polysomnography. Active counselling and vaccination recommendation was also missing in a small number of subjects.

Keywords

• adult vaccines
• chronic lung diseases
• pneumococcal infections