118. Rapid Uptake of 2014 ACIP Pneumococcal Vaccination Recommendations among Adults Aged 65 or Higher at the Veterans Health Administration

Abstract

Abstract Background Vaccination of the 13-valent pneumococcal conjugate vaccine (PCV13) for adults 65 years and older was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2014 until it was withdrawn in 2019. While estimated overall vaccination coverage rates with both vaccines at ∼30% were previously reported using data from surveys or Medicare claims, it is unclear how rapidly the uptake of this ACIP recommendation occurred. We aimed to describe the uptake of the ACIP among the Veterans Health Administration (VHA) population. Methods We conducted a retrospective cohort study of patients who were at 65 years or older in October 2014 who were registered in primary care of VHA. The study period was from October 2014 to November 2019. We obtained data on the first PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination and dropout from primary care follow-up due to death and termination of primary care relationship from the VHA Corporate Data Warehouse. We calculated the monthly proportion of PCV13 and PPSV23 vaccination among primary care follow-up patients in VHA. Results We enrolled 2,166,173 patients at the beginning of the study period (median age: 73 (interquartile range: 68–81)), and at the end of the study period, 30% (645,975) were dropout due to death. The numbers of patients who had at least one PCV13 and PPSV23 vaccination at the beginning of the study period were 17,718 (0.8%) and 934,836 (43.2%), respectively. Of the PCV13 used during the study period, 78.4% were administered in the first two years (Figure 1). At the end of the study period, 50.3% of the follow-up patients had been vaccinated with PCV13 and 53.3% with PPSV23 (Figure 2). 55.3% of patients received at least one dose of any vaccine, and 48.2% received both. Figure 1.Administered dose of first PCV13 and PPSV23 among the study populationFigure 2.The proportion of vaccination coverage among the study population Conclusion At the VHA, there was a very rapid uptake of 2014 ACIP pneumococcal vaccination recommendations in the first two years, followed by a steady increase. At the end of the study period, the VHA achieved comparable or higher vaccination coverage in this population with both PCV13 and PPSV23 than the previously reported Medicare population. Further studies are needed to elucidate factors contributing to this rapid uptake and improve the implementation of future vaccine recommendations. Disclosures Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.