Pneumococcal immunization: from policy to practice
Article Abstract:
Even though a vaccine against Streptococcus pneumoniae (the organism responsible for most cases of pneumonia that require hospitalization) is available, only 10 percent of the elderly and other high-risk groups actually get immunized. Pneumococcal vaccine is utilized less than vaccines against other diseases, such as influenza, but similar factors cause the overall low utilization of adult vaccines. These factors include a lack of emphasis on preventive care in the medical community, uncertainty regarding which patients are high-risk and should be vaccinated, and fear of side effects. Why is pneumococcal vaccine particularly underutilized? The disease is difficult to diagnose; in fact, the causative organism in one-third of all cases of pneumonia is never determined. Since only one-third of pneumonias are pneumococcal, even a vaccine with good effectiveness (60 to 70 percent) will appear to 'work' for only 20 percent of the patients who undergo immunization (the remainder will not have this type of pneumonia). Attempts to convince physicians of the value of pneumococcal vaccination have not been particularly successful, nor has patient education. Another approach is described in an article in the September 5, 1990, issue of The Journal of the American Medical Association. The authors propose the immunization of high-risk people at the time they are discharged from the hospital after treatment for other disorders. Although it is impossible to calculate the benefits of such a hospital-based immunization policy directly, an estimated one-half to three-quarters of discharged, eligible patients can be immunized in this fashion. The article presents a convincing cost-benefit analysis of the savings that accrue by preventing pneumococcal pneumonia; however, such arguments are not likely to be as compelling for hospitals (needing admissions) as for health maintenance organizations (needing to keep patients out of the hospital). Financial incentives could be provided to hospitals to encourage them to immunize discharged patients. It is time for medical practice to reflect the recommendations of public health policy regarding pneumococcal pneumonia vaccination. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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Hospital-based pneumococcal immunization: epidemiologic rationale from the Shenandoah study
Article Abstract:
While pneumococcal pneumonia causes much illness and death among the elderly, vaccination against the disease is not widely practiced. This is true in spite of the known effectiveness of vaccination for high-risk and elderly patients, most of whom have additional medical problems. Since many people who are hospitalized due to pneumococcal bacteremia (a systemic infection with the pneumococcus organism) have been previously discharged from a hospital within the preceding three to five years, it is possible that immunization at the time of hospital discharge could reduce the incidence of subsequent pneumococcal pneumonia. This was examined in an epidemiological study of hospital discharges of Medicare patients in the Shenandoah, Virginia area. Results showed that 11.1 percent of the 1,633 people aged 65 or over discharged from Shenandoah hospitals with pneumonia had a diagnosis of pneumococcal pneumonia. Approximately 61 percent of the whole group had been discharged from a Shenandoah hospital at least once within the previous four years, most often within the previous two years. Eighty-seven percent of these patients had at least one high-risk condition. The probability of hospital admission with pneumonia for a cohort of patients discharged from Shenandoah hospitals without a diagnosis of pneumonia was between 6 and 9 percent (depending on patients' ages) over a five-year period. Calculations of the probable effect of immunization against pneumococcal pneumonia showed that 100 or fewer discharged patients would need to be vaccinated to prevent one pneumonia readmission. Pneumococcal vaccination of elderly people is inexpensive compared with the cost of hospitalization for pneumonia, and the results provide epidemiologic support for a program of hospital-based pneumococcal immunization. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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Outbreaks of pneumococcal pneumonia among unvaccinated residents in chronic-care facilities - Massachusetts, October 1995, Oklahoma, February 1996, and Maryland, May-June 1996
Article Abstract:
All nursing home residents 65 years or older should receive pneumococcal vaccine to prevent infection with Streptococcus pneumoniae. This bacterium is a common cause of pneumonia in elderly nursing home residents. In Oct, 1995, 10 people in a Massachusetts nursing home developed pneumococcal pneumonia and 2 died. In Feb, 1996, 12 people at a Oklahoma facility contracted this infection and 3 died. In May-Jun, 1996, 14 people in a Maryland facility developed pneumococcal pneumonia and 4 died. Less than 5% of the residents at these facilities had been vaccinated.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1997
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