Abstract
BackgroundIn the UK certain groups with pre-disposing conditions are eligible for vaccination with the pneumococcal polysaccharide vaccine (PPV23). Uptake of the vaccine in these individuals has not been reported for 10 years. Hence this study investigated the rates of pneumococcal vaccination, the time to vaccination since diagnosis, and factors associated with vaccination in individuals aged 18–64 years with certain underlying medical conditions.MethodsA retrospective database analysis was conducted using the Clinical Practice Research Datalink (CPRD). Individuals aged 18 to 64 years who had a diagnosis for underlying medical conditions of interest at the index date (January 1, 2011 to December 31, 2015) were included in this study. Both underlying conditions and pneumococcal vaccination were identified using Read codes. A multivariable logistic regression model was used to identify factors associated with pneumococcal vaccination.ResultsA total of 99,153 individuals with underlying medical conditions were included in this study. Within 1 year of follow-up, 13.6% had received pneumococcal vaccination. This figure rose to 32.0% after 4 years of follow-up. The mean time between diagnosis and vaccination was 148.7 days across the overall cohort. Based on multivariate analysis of results, individuals with chronic heart disease, chronic kidney disease, chronic liver disease, chronic respiratory disease or diabetes mellitus were significantly less likely (P < 0.0001) to be vaccinated than those with immunosuppression. Individuals were significantly more likely to receive a pneumococcal vaccination if they received an influenza vaccination in the first year of follow-up than those who did not (P < 0.001).ConclusionsDespite the Joint Committee on Vaccination and Immunisation (JCVI) recommendations for pneumococcal vaccination in clinical risk groups, rates of pneumococcal vaccination are suboptimal in the UK for individuals aged 18–64 with underlying medical conditions. Further emphasis should be made on the importance of increased pneumococcal vaccination coverage in the UK, given the increased risk of morbidity and mortality associated with indicative underlying medical conditions.
Highlights
In the United Kingdom (UK) certain groups with pre-disposing conditions are eligible for vaccination with the pneumococcal polysaccharide vaccine (PPV23)
A retrospective cohort study was conducted using anonymised Electronic Health Record (EHR) data from the Clinical Practice Research Datalink (CPRD), a database jointly sponsored by the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health Research (NIHR), as part of the Department of Health (DoH) in the UK
Significantly lower vaccination coverage rates (VCR) compared to immunosuppressed patients. In both analyses conducted, individuals were over eight times more likely to receive a pneumococcal vaccination if they received an influenza vaccination in the first year of follow-up post index date than those who did not (Both: P < 0.0001)
Summary
In the UK certain groups with pre-disposing conditions are eligible for vaccination with the pneumococcal polysaccharide vaccine (PPV23). Uptake of the vaccine in these individuals has not been reported for 10 years. This study investigated the rates of pneumococcal vaccination, the time to vaccination since diagnosis, and factors associated with vaccination in individuals aged 18–64 years with certain underlying medical conditions. IPD is of significant public health concern due to high morbidity and mortality globally, especially in the very young, the elderly and individuals with underlying medical conditions [3]. Patients with chronic and immunocompromising conditions have been shown to have substantially increased rates and costs of treatment for IPD and all-cause pneumonia (ACP) when compared with those of healthy counterparts. An estimated 1548 deaths due to IPD occurred within the European Union (EU) in 2017, of which 1018 were reported by the UK [4]. Hospitalisations are an important contributor to this cost, with an estimated cost per episode of £4865 (patients aged 65 years) [7]
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