Kyaw Moe H, Greene Carolyn M, Schaffner William, Ray Susan M, Shapiro Miriam, Barrett Nancy L, Gershman Ken, Craig Allen S, Roberson Angela, Zell Elizabeth R, Schuchat Anne, Bennett Nancy M, Whitney Cynthia G
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Prev Med. 2006 Oct;31(4):286-92. doi: 10.1016/j.amepre.2006.06.007. Epub 2006 Aug 22.
The pneumococcal polysaccharide vaccine (PPV) can prevent invasive pneumococcal disease (IPD) in the elderly and those with certain underlying illnesses. However, vaccine uptake remains suboptimal. Identification of missed opportunities for vaccination could guide new strategies for improving uptake. Missed opportunities for vaccination were defined as one or more visits to a hospital, emergency room (ER), or main provider in the 2 years before infection among unvaccinated, adult IPD case-patients with a vaccine indication.
Adults aged 18 years or older with IPD were identified in six Active Bacterial Core surveillance/Emerging Infections Program Network sites during a 1-year period in 2001 to 2003. Using chart review, patient/proxy interview, a main provider questionnaire, and vaccine questionnaires from additional providers, data were collected on demographics, vaccine indications, vaccine status, and recent healthcare encounters.
A total of 1878 cases were enrolled, and 83% had a vaccine indication. Of the 1177 cases with a vaccine indication and sufficient information on recent healthcare encounters, 617 (52%) were unvaccinated. Of these, 566 (92%) had one or more opportunities for vaccination, 54% were hospitalized, 58% had ER visits, and 76% visited their main provider in the 2 years before illness. The number of visits to main providers (median = 6) was higher than hospitalizations (median = 1), and ER visits (median = 1).
One or more missed opportunities for vaccination were documented in nearly all unvaccinated IPD case-patients with a vaccine indication. Most visited their main provider multiple times. Implementation of systematic PPV programs in outpatient settings will likely increase pneumococcal vaccine uptake among high-risk adults.
肺炎球菌多糖疫苗（PPV）可预防老年人及患有某些基础疾病者发生侵袭性肺炎球菌病（IPD）。然而，疫苗接种率仍不理想。识别未接种疫苗的机会可指导提高接种率的新策略。未接种疫苗的成年IPD病例患者在感染前2年内到医院、急诊室（ER）或主要医疗服务提供者处就诊一次或多次被定义为未接种疫苗的机会。
在2001年至2003年的1年期间，在六个活性细菌核心监测/新发感染项目网络站点中识别出18岁及以上的IPD成年患者。通过查阅病历、患者/代理人访谈、主要医疗服务提供者问卷以及其他医疗服务提供者的疫苗问卷，收集有关人口统计学、疫苗适应证、疫苗接种状况和近期医疗接触的资料。
共纳入1878例病例，83%有疫苗适应证。在1177例有疫苗适应证且有足够近期医疗接触信息的病例中，617例（52%）未接种疫苗。其中，566例（92%）有一次或多次接种疫苗的机会，54%曾住院，58%去过急诊室，76%在发病前2年内看过主要医疗服务提供者。看主要医疗服务提供者的次数（中位数=6次）高于住院次数（中位数=1次）和急诊室就诊次数（中位数=1次）。
几乎所有有疫苗适应证但未接种疫苗的IPD病例患者都记录有一次或多次未接种疫苗的机会。大多数患者多次就诊于主要医疗服务提供者。在门诊环境中实施系统性PPV项目可能会提高高危成年人的肺炎球菌疫苗接种率。
