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Pneumococcal Vaccine in the Hospital: Improved Use and Implications for High-Risk Patients

Pneumococcal Vaccine in the Hospital: Improved Use and Implications for High-Risk Patients Abstract • A randomized trial of a program to improve pneumococcal immunization was undertaken. Also studied were the prevalence of high-risk conditions for serious pneumococcal disease among hospital admissions and prior hospitalization of patients with pneumococcal bacteremia. During two successive winters, 56% of 1,062 medical patients were identified by admission diagnosis or age as having a high-risk condition. None had received prior vaccination. During the trial period, identifying candidates for vaccination increased immunization from two (2.1%) of 95 to ten (10.4%) of 96 in year 1 and from two (2.1%) of 96 to 19 (20%) of 95 in year 2. Among adults with pneumococcal bacteremia, 33 (54%) of 61, including 32 (64%) of 50 with high-risk conditions, had documentation of prior hospitalization within five years. A hospital-based program can increase pneumococcal immunization rates and would be directed at patients in whom serious pneumococcal disease is likely to develop. (Arch Intern Med 1983;143:1878-1881) References 1. Statistical Abstract of the United States , ed 97. US Dept of Commerce, Bureau of Census, 1976, pp 61, 88. 2. World Health Statistics Annual: Vital Statistics and Causes of Death , Geneva, World Health Organization, 1976, vol 1. 3. Data from the National Center for Health Statistics: Acute conditions: Incidence and associated disability, United States July 1977-June 1978. Vital Health Stat 10 No. (132) , p 10. 4. Pneumococcal vaccine. The Medical Letter 1978;20:13-14. 5. Centers for Disease Control, Department of Health and Human Services: Pneumococcal polysaccharide vaccine recommendation of the immunization practices advisory committee. Ann Intern Med 1982;86: 203-205. 6. American College of Physicians: Pneumococcal vaccine recommendation. Ann Intern Med 1982;96:206-207.Crossref 7. Schwartz JS: Pneumococcal vaccine: Clinical efficacy and effectiveness. Ann Intern Med 1982;96:208-220.Crossref 8. Patriarca PA, Schlech WF, Hinman AR, et al: Pneumococcal vaccination practices among private physicians. Public Health Rep 1982;97:406-408. 9. Mufson MA: Pneumococcal infections. JAMA 1981;246:1942-1948.Crossref 10. MacFarlane JT, Ward MJ, Finch RG, et al: Hospital study of adult community-acquired pneumonia. Lancet 1982;2:255-258.Crossref 11. Austrian R, Gold J: Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann Intern Med 1964;60:759-776.Crossref 12. Mufson MA, Kraus DM, Wasil RE, et al: Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Intern Med 1974;134:505-510.Crossref 13. Heidelberger M, DiLapi MM, Siegel M, et al: Persistence of antibodies in human subjects injected with pneumococcal polysaccharides. J Immunol 1950;65:535-541. 14. Landesman SH, Schiffman G: Assessment of the antibody response to pneumococcal vaccine in high-risk populations. Rev Infect Dis 1981; 3( (suppl) ):S184-S196.Crossref 15. Willems JS, Sanders CR, Riddiough AM, et al: Cost effectiveness of vaccination against pneumococcal pneumonia. N Engl J Med 1980;303:553-559.Crossref 16. Patrick KM, Woolley FR: A cost-benefit analysis of immunization for pneumococcal pneumonia. JAMA 1981;245:473-477.Crossref 17. Broome CV: Efficacy of pneumococcal polysaccharide vaccines. Rev Infect Dis 1981;3( (suppl) ):S82-S88.Crossref 18. Austrian R: Some observations on the pneumococcus and on the current status of pneumococcal disease and its prevention. Rev Infect Dis 1981;3( (suppl) ):S1-S17.Crossref 19. Hirschmann JV, Lipsky BA: Pneumococcal vaccine in the United States: A critical analysis. JAMA 1981;246:1428-1432.Crossref 20. Austrian R: Prevention of pneumococcal infection by immunization with capsular polysaccharides of Streptococcus pneumoniae: Current status of polyvalent vaccines. J Infect Dis 1977;136( (suppl) ):S38-S42.Crossref 21. Ponka A, Leinonen M: Adverse reactions to polyvalent pneumococcal vaccine. Scand J Infect Dis 1982;14:67-71. 22. Ammann AJ, Schiffman G, Austrian R: The antibody responses to pneumococcal capsular polysaccharides in aged individuals. Proc Soc Exp Biol Med 1980;164:312-316.Crossref 23. Mufson MA, Oley G, Hughey D: Pneumococcal disease in a medium-sized community in the United States. JAMA 1982;248:1486-1489.Crossref 24. Fedson DS: Hospital-based pneumococcal immunization: The epidemiologic rationale and its implementation. Infect Control 1982;3:303-308. 25. Fedson DS, Baldwin FA: Previous hospital care as a risk factor for pneumonia implications for immunization with pneumococcal vaccine. JAMA 1982;248:1989-1995.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Pneumococcal Vaccine in the Hospital: Improved Use and Implications for High-Risk Patients

Archives of Internal Medicine , Volume 143 (10) – Oct 1, 1983

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350100040012
Publisher site
See Article on Publisher Site

Abstract

Abstract • A randomized trial of a program to improve pneumococcal immunization was undertaken. Also studied were the prevalence of high-risk conditions for serious pneumococcal disease among hospital admissions and prior hospitalization of patients with pneumococcal bacteremia. During two successive winters, 56% of 1,062 medical patients were identified by admission diagnosis or age as having a high-risk condition. None had received prior vaccination. During the trial period, identifying candidates for vaccination increased immunization from two (2.1%) of 95 to ten (10.4%) of 96 in year 1 and from two (2.1%) of 96 to 19 (20%) of 95 in year 2. Among adults with pneumococcal bacteremia, 33 (54%) of 61, including 32 (64%) of 50 with high-risk conditions, had documentation of prior hospitalization within five years. A hospital-based program can increase pneumococcal immunization rates and would be directed at patients in whom serious pneumococcal disease is likely to develop. (Arch Intern Med 1983;143:1878-1881) References 1. Statistical Abstract of the United States , ed 97. US Dept of Commerce, Bureau of Census, 1976, pp 61, 88. 2. World Health Statistics Annual: Vital Statistics and Causes of Death , Geneva, World Health Organization, 1976, vol 1. 3. Data from the National Center for Health Statistics: Acute conditions: Incidence and associated disability, United States July 1977-June 1978. Vital Health Stat 10 No. (132) , p 10. 4. Pneumococcal vaccine. The Medical Letter 1978;20:13-14. 5. Centers for Disease Control, Department of Health and Human Services: Pneumococcal polysaccharide vaccine recommendation of the immunization practices advisory committee. Ann Intern Med 1982;86: 203-205. 6. American College of Physicians: Pneumococcal vaccine recommendation. Ann Intern Med 1982;96:206-207.Crossref 7. Schwartz JS: Pneumococcal vaccine: Clinical efficacy and effectiveness. Ann Intern Med 1982;96:208-220.Crossref 8. Patriarca PA, Schlech WF, Hinman AR, et al: Pneumococcal vaccination practices among private physicians. Public Health Rep 1982;97:406-408. 9. Mufson MA: Pneumococcal infections. JAMA 1981;246:1942-1948.Crossref 10. MacFarlane JT, Ward MJ, Finch RG, et al: Hospital study of adult community-acquired pneumonia. Lancet 1982;2:255-258.Crossref 11. Austrian R, Gold J: Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann Intern Med 1964;60:759-776.Crossref 12. Mufson MA, Kraus DM, Wasil RE, et al: Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Intern Med 1974;134:505-510.Crossref 13. Heidelberger M, DiLapi MM, Siegel M, et al: Persistence of antibodies in human subjects injected with pneumococcal polysaccharides. J Immunol 1950;65:535-541. 14. Landesman SH, Schiffman G: Assessment of the antibody response to pneumococcal vaccine in high-risk populations. Rev Infect Dis 1981; 3( (suppl) ):S184-S196.Crossref 15. Willems JS, Sanders CR, Riddiough AM, et al: Cost effectiveness of vaccination against pneumococcal pneumonia. N Engl J Med 1980;303:553-559.Crossref 16. Patrick KM, Woolley FR: A cost-benefit analysis of immunization for pneumococcal pneumonia. JAMA 1981;245:473-477.Crossref 17. Broome CV: Efficacy of pneumococcal polysaccharide vaccines. Rev Infect Dis 1981;3( (suppl) ):S82-S88.Crossref 18. Austrian R: Some observations on the pneumococcus and on the current status of pneumococcal disease and its prevention. Rev Infect Dis 1981;3( (suppl) ):S1-S17.Crossref 19. Hirschmann JV, Lipsky BA: Pneumococcal vaccine in the United States: A critical analysis. JAMA 1981;246:1428-1432.Crossref 20. Austrian R: Prevention of pneumococcal infection by immunization with capsular polysaccharides of Streptococcus pneumoniae: Current status of polyvalent vaccines. J Infect Dis 1977;136( (suppl) ):S38-S42.Crossref 21. Ponka A, Leinonen M: Adverse reactions to polyvalent pneumococcal vaccine. Scand J Infect Dis 1982;14:67-71. 22. Ammann AJ, Schiffman G, Austrian R: The antibody responses to pneumococcal capsular polysaccharides in aged individuals. Proc Soc Exp Biol Med 1980;164:312-316.Crossref 23. Mufson MA, Oley G, Hughey D: Pneumococcal disease in a medium-sized community in the United States. JAMA 1982;248:1486-1489.Crossref 24. Fedson DS: Hospital-based pneumococcal immunization: The epidemiologic rationale and its implementation. Infect Control 1982;3:303-308. 25. Fedson DS, Baldwin FA: Previous hospital care as a risk factor for pneumonia implications for immunization with pneumococcal vaccine. JAMA 1982;248:1989-1995.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1983

References