Pneumococcal Vaccination is a Challenge of Pediatric Allergists

Objective: An increased risk of invasive pneumococcal disease (IPD) has been reported in children with asthma before the introduction of pneumococcal vaccines (PVs). However, the evidence is limited after PV entered the routine immunization schedule. We aimed to investigate whether pediatric allergists recommend additional PV (aPV) to asthmatic children and if so whether there are any asthma-specific risk factors they consider. We also wanted to determine any changes in their recommendations during the COVID-19 pandemic. Material(s) and Method(s): A questionnaire was e-mailed to all members of the Academy of Pediatric Allergy and Asthma in Turkey. The questionnaire was filled online and consisted of 14 questions. Result(s): The questionnaire was e-mailed to 220 members. The response rate was 56.3% and 60.5% of PA recommended aPV. The most frequent asthma specific factors for aPV were severe asthma (70.2%), long term oral corticosteroid use (65.3%) and frequent exacerbations / hospitalizations (62.9%). COVID-19 pandemic increased the rate of questions asked to PA about aPV for asthmatic children compared to previous periods (75.8 vs 33.9%) (p<0.001) and %27 of PA changed their recommendations in favor of aPV during pandemic. Conclusion(s): Asthmatic children is not infrequent. Severe asthma and related factors seem to be the leading reasons to recommend aPV for asthmatic children. The aPV recommendation by PA is increased during COVID-19 pandemic.Copyright © 2022 Bilimsel Tip Yayinevi. All rights reserved.

The Reality and Prospects of Pneumococcal Vaccination during the COVID-19 Pandemic

Relevance. Pneumococcal infection (PI) is one of the leading causes of disability and death of older people worldwide. In the Astrakhan region, as in other regions of the Russian Federation, there is a low coverage of pneumococcal vaccination (PV) and amounts to 1.3% of the adult population. This study reflects the regional problem of PV, an evaluation of its effectiveness in reducing exacerbations and the development of community-acquired pneumonia (CAP) in patients with COPD. The impact of pneumococcal infection (PI) in the development of pneumonia turned out in the period of the COVID-19 pandemic so far to be the most significant. Aim of this work was to evaluate the level of doctor’s awareness in the issues of pneumococcal vaccination, as well as the results of its implementation in patients with COPD during COVID-19 pandemic. Materials and methods. The study was conducted in the form of a survey in the period from October 2021 to February 2022. A survey was conducted through a questionnaire poll in polyclinics and pulmonology departments of multidisciplinary hospitals in Astrakhan. A total of 201 doctors and 173 patients suffering from COPD participated in the study. The doctors' responses were compared with the results of the survey conducted in 2018. Results. This study shows that 26% of the surveyed patients with COPD were vaccinated with pneumococcal vaccine. Analysis of clinical effects after vaccination shows that exacerbations of COPD were absent during the year in 51.1% of vaccinated patients, and 35.2% in non-vaccinated group. The prevalence of CAP in vaccinated patients was 13.3% vs 32.4% in patients who did not receive vaccination. Conclusion. This study showed a significant level of clinical efficacy of PV, characterized by a reduced incidence of COPD exacerbations and the development of VP in vaccinated patients, as well as a lower number of hospitalizations. Vaccinated patients reported mild severity of coronavirus infection, which determines the high prospects for further PV research as one of the important measures to counteract the COVID-19 pandemic. The problem of awareness in specialists about pneumococcal vaccination requires further improvement of educational programs on the relevant topic in the framework of continuing medical education. © 2022, Numikom. All rights reserved.

Pneumococcal Vaccination is a Challenge of Pediatric Allergists

Objective: An increased risk of invasive pneumococcal disease (IPD) has been reported in children with asthma before the introduction of pneumococcal vaccines (PVs). However, the evidence is limited after PV entered the routine immunization schedule. We aimed to investigate whether pediatric allergists recommend additional PV (aPV) to asthmatic children and if so whether there are any asthma-specific risk factors they consider. We also wanted to determine any changes in their recommendations during the COVID-19 pandemic. Materials and Methods: A questionnaire was e-mailed to all members of the Academy of Pediatric Allergy and Asthma in Turkey. The questionnaire was filled online and consisted of 14 questions. Results: The questionnaire was e-mailed to 220 members. The response rate was 56.3% and 60.5% of PA recommended aPV. The most frequent asthma specific factors for aPV were severe asthma (70.2%), long term oral corticosteroid use (65.3%) and frequent exacerbations / hospitalizations (62.9%). COVID-19 pandemic increased the rate of questions asked to PA about aPV for asthmatic children compared to previous periods (75.8 vs 33.9%) (p<0.001) and %27 of PA changed their recommendations in favor of aPV during pandemic.Conclusion: Asthmatic children is not infrequent. Severe asthma and related factors seem to be the leading reasons to recommend aPV for asthmatic children. The aPV recommendation by PA is increased during COVID-19 pandemic.

Low Adherence to Pneumococcal Vaccination in Lung Cancer Patients in a Tertiary Care University Hospital in Southern Germany.

INTRODUCTION: The aim of this study was to investigate the adherence to vaccinations, especially pneumococcal vaccinations, in lung cancer patients. METHODS: the study was performed at the University Hospital Regensburg, Germany. All patients with a regular appointment scheduled between 1 December 2020 and 29 April 2021 and who provided informed consent were included. Available medical records, vaccination certificates, and a questionnaire were analyzed. RESULTS: we included 136 lung cancer patients (NSCLC n = 113, 83.1%, SCLC n = 23, 16.9%). A correct pneumococcal vaccination according to national recommendations was performed in 9.4% (12/127) of the patients. A correct vaccination was performed for tetanus in 50.4% (66/131), diphtheria in 34.4% (44/128), poliomyelitis in 25.8% (33/128), tick-borne encephalitis in 40.7% (24/59), hepatitis A in 45.5% (7/11), hepatitis B in 38.5% (5/13), shingles in 3.0% (3/101), measles in 50.0% (3/6), pertussis in 47.7% (62/130), influenza in 54.4% (74/136), and meningococcal meningitis in 0% (0/2) of the patients. CONCLUSION: adherence to pneumococcal vaccinations, as well as to other vaccinations, is low in lung cancer patients.

Promising Expectations for Pneumococcal Vaccination during COVID-19.

The emergence of new viral infections has increased over the decades. The novel virus is one such pathogen liable for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, popularly known as coronavirus disease 2019 (COVID-19). Most fatalities during the past century's influenza pandemics have cooperated with bacterial co/secondary infections. Unfortunately, many reports have claimed that bacterial co-infection is also predominant in COVID-19 patients (COVID-19 associated co/secondary infection prevalence is up to 45.0%). In the COVID-19 pandemic, Streptococcus pneumoniae is the most common coinfecting pathogen. Half of the COVID-19 mortality cases showed co-infection, and pneumonia-related COVID-19 mortality in patients >65 years was 23%. The weakening of immune function caused by COVID-19 remains a high-risk factor for pneumococcal disease. Pneumococcal disease and COVID-19 also have similar risk factors. For example, underlying medical conditions on COVID-19 and pneumococcal diseases increase the risk for severe illness at any age; COVID-19 is now considered a primary risk factor for pneumococcal pneumonia and invasive pneumococcal disease. Thus, pneumococcal vaccination during the COVID-19 pandemic has become more critical than ever. This review presents positive studies of pneumococcal vaccination in patients with COVID-19 and other medical conditions and the correlational effects of pneumococcal disease with COVID-19 to prevent morbidity and mortality from co/secondary infections and superinfections. It also reports the importance and role of pneumococcal vaccination during the current COVID-19 pandemic era to strengthen the global health system.

Leveraging Interdisciplinary Teams for Pre-Visit Planning to Improve Pneumococcal Immunization Rates Among Internal Medicine Subspecialty Practices.

BACKGROUND: Despite the ready availability of pneumococcal vaccines and recommendation of vaccination by Center for Disease Control and Prevention (CDC), the immunization rates among adults less than 65 years of age with chronic and immunocompromised conditions remain low. METHODS: This interventional (cohort) study aimed to improve the pneumococcal vaccination rate for patients with an increased risk of pneumococcal disease by utilizing a three-pronged approach. This included: (1) clinician education webinar, (2) pre-visit counseling performed by registered nurses, targeted toward patients with upcoming appointments, to address vaccination status, and (3) modified pre-visit interdisciplinary team huddle with clinicians and registered nurses to review which patients are amenable to vaccination at the time of visit and those who may benefit from re-engagement and further motivational interviewing. After the completion of the 10-week intervention, study organizers reviewed the percent of patients with completed pneumococcal vaccinations. RESULTS: In this 10-week rapid cycle initiative, a total of 482 patients were eligible for vaccination. During the intervention phase, 370 patients were contacted and of these 38% of patients were amenable to receiving a vaccine during the pre-visit counseling, 5% were previously vaccinated, 18% were not amenable, and 38% were unreachable prior to visit. This initiative resulted in a 43% increase in the vaccination rate in this cohort. CONCLUSIONS: The significant increase in vaccination rate supports the utilization of a framework in the multidisciplinary approach to pre-visit planning in non-primary care specialties and other vaccination efforts, especially emerging diseases such as COVID-19. Future directions of study include the efficacy of telemedicine counseling with a same-day appointment for vaccination, co-location of registered nurses within the practice sites, as well as the use of other ancillary staff (such as medical office assistants) to engage patients in pre-visit planning.

The COVID-19 pandemic increased the demand for pneumococcal vaccination in Japan.

Although routine vaccinations in children decreased during the coronavirus disease 2019 (COVID-19) pandemic, pneumococcal vaccine coverage in older adults has remained unknown. This study was performed to investigate the impact of the COVID-19 pandemic on pneumococcal vaccination in Japan. The numbers of 23-valent pneumococcal polysaccharide vaccines (PPV23) shipped was obtained from an office memorandum released by the Ministry of Health, Labor and Welfare. The results showed that the COVID-19 pandemic increased the need for pneumococcal vaccination, causing shipping restrictions of pneumococcal vaccines. Regular vaccination is still important because there may be a shortage of vaccines during a pandemic.

Should older adult pneumococcal vaccination recommendations change due to decreased vaccination in children during the pandemic? A cost-effectiveness analysis.

BACKGROUND: The COVID-19 pandemic is causing declines in childhood immunization rates. We examined potential COVID-19-related changes in pediatric 13-valent pneumococcal conjugate vaccine (PCV13) use, subsequent impact on childhood and adult pneumococcal disease rates, and how those changes might affect the favorability of PCV13 use in non-immunocompromised adults aged ≥65 years. METHODS: A Markov model estimated pediatric disease resulting from decreased PCV13 use in children aged <5 years; absolute decreases from 10 to 50% for 1-2 years duration were examined, assuming no catch-up vaccination and that decreased vaccination led to proportionate increases in PCV13 serotype pneumococcal disease in children and seniors. Integrating pediatric model output into a second Markov model examining 65-year-olds, we estimated the cost effectiveness of older adult pneumococcal vaccination strategies while accounting for potential epidemiologic changes from decreased pediatric vaccination. RESULTS: One year of 10-50% absolute decreases in PCV13 use in <5-year-olds increased pneumococcal disease by an estimated 4-19% in seniors; 2 years of decreased use increased senior rates by 8-38%. In seniors, a >53% increase in pneumococcal disease was required to favor PCV13 use in non-immunocompromised seniors at a $200,000 per quality-adjusted life-year gained threshold, which corresponded to absolute decreases in pediatric PCV13 vaccination of >50% over a 2-year period. In sensitivity analyses, senior PCV13 vaccination was unfavorable if absolute decreases in pediatric PCV13 receipt were within plausible ranges, despite model assumptions favoring PCV13 use in seniors. CONCLUSION: COVID-19-related decreases in pediatric PCV13 use would need to be both substantial and prolonged to make heightened PCV13 use in non-immunocompromised seniors economically favorable.

Influenza and pneumococcal vaccinations are not associated to COVID-19 outcomes among patients admitted to a university hospital.

In order to reduce the burden on healthcare systems and to support differential diagnosis with COVID-19, influenza and pneumococcal vaccinations were strongly recommended during the COVID-19 pandemic, especially in vulnerable groups. However, no univocal and conclusive evidence on the relationship between influenza and pneumococcal vaccinations and COVID-19 outcomes exists. We evaluated the association between such vaccinations, COVID-19 hospitalization, intensive care unit admissions and deaths in a cohort (N = 741) of COVID-19 patients who had access to the emergency room of a large Italian University hospital between March 1, 2020 and June 1, 2020. Results show that influenza and pneumococcal vaccinations did not affect hospitalization, intensive care unit admission and deaths in COVID-19 patients in the overall sample and in those ≥65 years. The same pattern of results was confirmed considering timing of influenza vaccine administration, vaccination type, and number of uptakes in the last five vaccination campaigns. In conclusion, our study does not support an impact of influenza and pneumococcal vaccinations on COVID-19 outcomes.

Improving Pneumococcal Vaccination Rates among Rural Older Adults through Academic Detailing: Medicine, Nursing and Pharmacy Partnership.

Academic detailing is an educational approach involving provision of evidence-based information by healthcare providers for healthcare providers with the goal of improving clinical decision-making. An interprofessional academic detailing initiative was developed to encourage rural providers to utilize guidelines when deciding which patients to vaccinate against pneumonia. This study utilized a quasi-experimental, single-group, pre-post observational design with physicians, nurses, and staff at two rural medical clinics. The 12-month academic detailing intervention included a needs assessment, workflow assessment of practice-based health information technology, vaccination training for providers and staff, and creation of exam-room posters encouraging patients to discuss vaccination with their provider. Six visits were made to deliver education, discuss needs, select priorities, and develop action plans from recommendations. Data were collected from each site for three years prior to the intervention year and for one year following the intervention. The annual rate of patients vaccinated increased during the five-year study. The cumulative proportion of the sample population that received vaccination also increased over time. Interprofessional academic detailing was well received and increased pneumococcal vaccination rates among rural-dwelling older adults. Given the alarming disparities in health outcomes for rural patients, educational outreach is needed to improve healthcare access and outcomes.

Factors associated with intention to uptake pneumococcal vaccines among Chinese elderly aged 60 years and older during the early stage of COVID-19 pandemic.

Innoculation of pneumococcal vaccines among the elderly is an effective public health policy to prevent pneumococcal diseases and it is widely promoted by many developed countries. The pneumococcal vaccination rate among the elderly in China was only 3.7% in 2019, it grew rapidly during the early stage of the COVID-19 pandemic. The purpose of this cross-sectional study was to investigate the psychological and demographic-economic factors related to the uptake behavior of pneumococcal vaccination among the Chinese elderly by using an integrated model based on the unified theory of acceptance and use of technology (UTAUT), and knowledge, attitudes and practices (KAP). The theoretical model was tested via structural equation modeling (SEM) with data collected from 516 Chinese older adults aged 60 years and older. Our results suggested that knowledge, performance expectancy, effort expectancy, attitude, and trust had a significant correlation with behavioral intention; behavioral intention and trust had a positive correlation with the uptake behavior, gender, and and education level and chronic obstructive pulmonary disease exerted significant moderating effects. To increase the coverage of pneumococcal vaccination among the elderly, it is necessary to provide effective health education by authoritative experts, thereby enhancing their knowledge and positive attitude towardthe vaccination.

Influenza and Pneumococcal Vaccination in Non-Infected Cardiometabolic Patients from the Americas during the COVID-19 Pandemic. A Sub-Analysis of the CorCOVID-LATAM Study.

BACKGROUND: Influenza vaccination (IV) and Pneumococcus vaccination (PV) are recommended for patients with cardiometabolic diseases. This study aimed to evaluate the immunization rate of ambulatory cardiometabolic patients during the COVID-19 pandemic in the Americas. METHODS: Electronic surveys were collected from 13 Spanish speaking countries between 15 June and 15 July 2020. RESULTS: 4216 patients were analyzed. Mean age 60 (±15) years and 49% females. Global IV rate was 46.5% and PV 24.6%. Vaccinated patients were older (IV = 63 vs. 58 years; PV = 68 vs. 59, p < 0.01) but without gender difference. Vaccination rates were greater in higher-risk groups (65+, diabetics, heart failure), but not in coronary artery disease patients. In the Southern cone, the rate of IV and PV was approximately double that in the tropical regions of the Americas. In a multivariate model, geographic zone (IV = OR 2.02, PV = OR 2.42, p < 0.001), age (IV = OR 1.023, PV = OR 1.035, p < 0.001), and incomes (IV = OR 1.28, PV = OR 1.58, p < 0.001) were predictors for vaccination. CONCLUSIONS: During the COVID-19 pandemic, ambulatory patients with cardiometabolic diseases from the Americas with no evidence of COVID-19 infection had lower-than-expected rates of IV and PV. Geographic, social, and cultural differences were found, and they should be explored in depth.

The Association between Influenza and Pneumococcal Vaccinations and SARS-Cov-2 Infection: Data from the EPICOVID19 Web-Based Survey.

The present study aims to evaluate whether influenza and pneumococcal vaccinations are associated with positive nasopharyngeal swab (NPS) testing to detect SARS-CoV-2. Data from the Italian cross-sectional web-based survey (EPICOVID19), based on a self-selection sample of individuals aged ≥18, were considered. The probability of a positive SARS-CoV-2 NPS test result as a function of influenza or anti-pneumococcal vaccination was evaluated using multivariable logistic regression, stratifying analysis by age (<65 years, ≥65 years). From April 2020, 170,731 individuals aged <65 years and 28,097 ≥65 years filled out the EPICOVID19 questionnaire. Influenza and anti-pneumococcal vaccinations were received, respectively, by 16% and 2% of those <65 years, and by 53% and 13% of those ≥65 years. SARS-CoV-2 NPS testing was reported by 6680 participants. Anti-pneumococcal and influenza vaccinations were associated with a decreased probability of a SARS-CoV-2 NPS positive test in the younger participants (OR = 0.61, 95% CI 0.41-0.91; OR = 0.85, 95%CI 0.74-0.98; respectively). A significantly lower probability of a positive test result was detected in the individuals ≥65 years who received anti-pneumococcal vaccination (OR = 0.56, 95%CI 0.33-0.95). These results need to be confirmed by further investigations, but they are relevant given the probable coexistence of influenza, bacterial infections, and COVID-19 over the coming autumn-winter season.