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Won H, Kim JA, Jeong NY, Choi NK. Safety of concomitant administration of 23-valent polysaccharide pneumococcal vaccine and influenza vaccine among the elderly. Vaccine 2024; 42:3190-3196. [PMID: 38641496 DOI: 10.1016/j.vaccine.2024.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/24/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The current recommendation for the elderly is to receive both a single dose 23-valent pneumococcal polysaccharide vaccine (PPSV-23) and an annual inactivated influenza vaccine. There is a lack of post-marketing safety studies on concomitant vaccination using real-world data. We aimed to evaluate the safety of administering PPSV-23 and influenza vaccine concomitantly versus sequentially. METHODS We performed a retrospective cohort study using a linked database that combines vaccination registry from the Korea Disease Control and Prevention Agency and claims data from the National Health Insurance Service. The study population included all those aged over 65 who received PPSV-23 at least once from Jan 1, 2016, to Dec 31, 2020. This study evaluated the 16 prespecified events of interest. Concomitant vaccination was defined as receiving both PPSV-23 and influenza vaccine on the same day. For sequential vaccination, we defined it as receiving influenza vaccination during the period from 30 to 365 days prior to the date of PPSV-23 injection. We performed 1:4 propensity score matching and estimated adjusted incidence rate ratio (aIRR) with a 95 % confidence interval (CI) using conditional Poisson regression. RESULTS Of the 2,885,144 elderly patients who received PPSV-23 vaccination at least once from Jan 1, 2016, to Dec 31, 2020, a total 87,899 were included in the concomitant vaccination group and 1,200,091 were included in the sequential vaccination group. After adjusting for confounders, the concomitant group exhibited a significantly lower risk of allergic reactions (aIRR: 0.71, 95 % CI: 0.58-0.87), neuritis (aIRR: 0.72, 95 % CI: 0.57-0.91), and pneumonia (aIRR: 0.85, 95 % CI: 0.80-0.90), while demonstrating significantly higher risks of paralysis (aIRR: 1.63, 95 % CI: 1.05-2.52) compared to the sequential group. CONCLUSIONS Concomitant administration of PPSV-23 and influenza vaccine in the elderly was not associated with a higher risk of most prespecified adverse events (AEs) compared to sequential vaccination. This study supports the safety of concomitant administration of PPSV-23 and influenza vaccine.
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Affiliation(s)
- Heehyun Won
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Ah Kim
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Na-Young Jeong
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea; Graduate School of Industrial Pharmaceutical Science, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea.
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Born S, Fleischmann-Struzek C, Abels W, Piedmont S, Neugebauer E, Reinhart K, Toubekis E, Wegwarth O, Schwarzkopf D. Most patients with an increased risk for sepsis-related morbidity or death do not recognize sepsis as a medical emergency: results of a survey study using case vignettes. Crit Care 2023; 27:446. [PMID: 37978408 PMCID: PMC10655489 DOI: 10.1186/s13054-023-04733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sepsis is a medical emergency with potentially life-threatening consequences. Patients play a crucial role in preventing and recognizing sepsis at an early stage. The understanding of risk groups' sepsis knowledge and their ability to use this knowledge to recognize sepsis as an emergency is incomplete. METHODS We conducted a cross-sectional survey in Germany and included a sample of 740 persons stratified by age (< 60 years, ≥ 60 years), specific chronic diseases (e.g. diabetes, chronic diseases, cancer), and region (Berlin/Brandenburg vs. other federal states of Germany). Standardized questionnaires were administered by a market research institute through online, telephone, or face-to-face methods. We assessed sepsis knowledge through a series of questions and the ability to recognize sepsis as an emergency through five case vignettes. To identify predictors of sepsis knowledge and the ability to recognize sepsis as a medical emergency, we conducted multiple linear regressions. RESULTS Of the 36 items on sepsis knowledge, participants answered less than 50 per cent correctly (mean 44.1%; standard deviation (SD) 20.1). Most patients knew that sepsis is a defensive host response to infection (75.9%), but only 30.8% knew that vaccination can prevent infections that lead to sepsis. Across the five vignettes, participants identified sepsis as an emergency in only 1.33 of all cases on average (SD = 1.27). Sepsis knowledge was higher among participants who were older, female, and more highly educated and who reported more extensive health information seeking behaviour. The ability to recognize sepsis as an emergency was higher among younger participants, participants without chronic diseases, and participants with higher health literacy, but it was not significantly associated with sepsis knowledge. CONCLUSIONS Risk groups showed low levels of knowledge regarding the preventive importance of vaccination and a low ability to recognize sepsis as a medical emergency. Higher levels of sepsis knowledge alone were not sufficient to improve the ability to identify sepsis as a medical emergency. It is crucial to develop effective educational strategies-especially for persons with lower education levels and infrequent health information seeking behaviour-that not only transfer but also facilitate the choice of appropriate actions, such as seeking timely emergency care. TRIAL REGISTRATION DRKS00024561. Registered 9 March 2021.
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Affiliation(s)
- Sebastian Born
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany.
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Wiltrud Abels
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sepsis Foundation, Berlin, Germany
| | - Silke Piedmont
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Emergency Medicine Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sepsis Foundation, Berlin, Germany
| | - Evjenia Toubekis
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Odette Wegwarth
- Heisenberg Chair for Medical Risk Literacy and Evidence-Based Decisions, Clinic for Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Daniel Schwarzkopf
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Storch J, Meissner F, Böde M, Kwetkat A, Pletz MW, Freytag A. [Once vaccinated, always vaccinated? A claims data analysis on repeated influenza vaccinations among individuals aged ≥ 60 years]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:953-961. [PMID: 37291252 PMCID: PMC10249936 DOI: 10.1007/s00103-023-03716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Standing Committee on Vaccination recommends the seasonal influenza vaccination as a standard vaccination for individuals aged ≥ 60 years and as an indication vaccination independent of age. Empirical data on repeated vaccination are not available for Germany. The aim of this study was therefore to investigate the frequency and influencing factors of repeated vaccinations. METHODS We conducted a longitudinal retrospective observational study with claims data from ≥ 60‑year-olds insured with the statutory health insurance AOK Plus in Thuringia between 2012 and 2018. The number of seasons with influenza vaccination was described and the association with various individual characteristics was analysed in a regression model. RESULTS Included were 103,163 individuals with at least one influenza vaccination in the 2014/2015 season, of whom 75.3% had been vaccinated in ≥ 6 of 7 seasons. We found repeated vaccinations more frequently among nursing home residents (rate ratio (RR) 1.27), individuals with increased health risk due to underlying diseases (RR 1.21) and higher age groups (vs. 60-69 years: RR 1.17-1.25). With each additional year of participating in a disease management program, the number of vaccinations increased (RR 1.03). Women (RR 0.91), individuals with nursing care level 1 (vs. no nursing care level: RR 0.90) and people with a comorbidity (vs. no comorbidity: RR 0.97) were less likely to receive repeated vaccinations. DISCUSSION A large proportion of individuals aged ≥ 60 years who have been vaccinated against influenza once is likely to repeatedly receive vaccinations. In accordance with vaccination recommendations, nursing home residents and in particular individuals with an increased health risk are vaccinated repeatedly. General practitioners play a central role: non-acute patient contacts should be used to offer vaccinations, especially to women and individuals in need of care who are living at home.
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Affiliation(s)
- Josephine Storch
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland.
- Internationale Graduierten Akademie, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Franziska Meissner
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
| | - Monique Böde
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
| | - Anja Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück, Osnabrück, Deutschland
| | - Mathias W Pletz
- Universitätsklinikum Jena, Institut für Infektionsmedizin und Krankenhaushygiene, Friedrich-Schiller-Universität, Jena, Deutschland
| | - Antje Freytag
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
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Storch J, Fleischmann-Struzek C, Rose N, Lehmann T, Mikolajetz A, Maddela S, Pletz MW, Forstner C, Wichmann O, Neufeind J, Vogel M, Reinhart K, Vollmar HC, Freytag A. The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:67-80. [PMID: 34283323 PMCID: PMC8882088 DOI: 10.1007/s10198-021-01343-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/01/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND To date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care. METHODS Retrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias. RESULTS Influenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of - €178.87 [95% CI - €240.03;- €117.17] per individual (2015: - €50.02 [95% CI - €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [- €9.43; 95% CI - €17.56;- €1.30] and 2016 [- €12.93; 95% CI - €25.37;- €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out. CONCLUSION Influenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.
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Affiliation(s)
- Josephine Storch
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
- International Graduate Academy, Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | | | - Norman Rose
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany
| | - Anna Mikolajetz
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Srikanth Maddela
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christina Forstner
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel, 18-20, 1090, Vienna, Austria
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Julia Neufeind
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Monique Vogel
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Konrad Reinhart
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, BIH Visiting Professor/Charité Foundation, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
- Institute of General Practice and Family Medicine, Medical Faculty, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.
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