Even though community-acquired pneumonia (CAP) is highly preventable through vaccination, immunization rates remain suboptimal, a new study emphasizes.

In the United States, a public-health target of 90% pneumococcal vaccination coverage by the year 2020 in adults aged 65 years and older has been established, according to a report in the Journal of Infection and Public Health. In addition, it points out, the CDC recommends vaccination for younger patients with immunosuppression, chronic pulmonary disease, asplenia, cerebrospinal fluid leak, or cochlear implants.

The CDC’s Advisory Committee on Immunization Practices recommends pneumococcal vaccination for high-risk adults with one dose of pneumococcal conjugate vaccine (PCV13) and at least one dose of pneumococcal polysaccharide vaccine (PPSV23), depending on age and health status. In older adults, one dose of PCV13 is recommended, followed by a dose of PPSV23 at least 1 year later regardless of vaccination status earlier in life.

University of Florida–led researchers suggest that at least part of the shortfall in vaccination rates is because of missed opportunities for vaccination, defined by the World Health Organization as “any contact with a health service that did not result in…receiving the needed vaccines.”

“While missed vaccination opportunities have been extensively studied in children and in other populations, missed opportunities for pneumococcal vaccinations in high-risk adult populations have not been fully explored,” note the researchers. They posit that the number of missed opportunities for pneumococcal vaccinations is elevated in high-risk adult populations, suggesting that the following factors are at play:
• Patient refusal,
• Lack of provider recommendation, and
• Lack of ability to pay for vaccines.

To test that hypothesis, the study team focused on a cohort from the 2015 National Health Interview Survey of nearly 17,000 adults, about one-half of whom were older than age 65 years; the rest were younger but had acknowledged pneumonia risk factors. The overall pneumococcal vaccination rate was 23% in younger adults at high risk and 63.8% in older adults.

The study found that in younger high-risk adults, the highest vaccination coverage was among those with home health care (56% vaccinated) and was increased among those with emergency department (ED) visits (31% vaccinated) or hospitalizations (40.9% vaccinated) compared with those without these types of visits.

For older adults, meanwhile, healthcare interactions also played a key role in vaccination; 74% who had been hospitalized were vaccinated versus 61.8% who had not. At the same time, coverage rates for pneumococcal vaccines for those with ED visits was 70.7%, with home care 76.2%, and with office visits 66.0%.

The researchers point out, however, that in adults aged 18 to 64 years at risk for pneumonia, an average of 4.83 (95% CI, 4.66-4.99) healthcare encounters occurred in those without pneumonia vaccines, with office visits accounting for 79.8% of missed opportunities and pneumococcal vaccinations.

Healthcare encounters were even higher, an average of 5.15 (95% CI, 4.90-5.39), in older adults who had not received pneumococcal vaccination, with most of the missed opportunities occurring in physician offices.

“This is the first known study to report missed opportunities for pneumonia vaccination in adults,” study authors write. “Quantifying missed opportunities for pneumonia vaccination is important given the large clinical and economic burden for pneumonia. Based on the findings of this study, high-risk adult populations had up to five encounters with the healthcare system that did not result in vaccination. Each encounter is an opportunity for recommendations by providers which are highly influential on patient health behaviors.”

The authors recommend that pharmacists and other healthcare providers be continuously aware of the importance of assessing vaccination status of older adults and high-risk patients they encounter.

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