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Shivamadhu S, Jalal AM, Sandhu AS, Persad N, Satram C, Nalajala N, Osorio Tapia LM, Vera E, Sunkara SM, Salazar EF, Khan A, Ehsan M, Swed S. Immunizing hearts: exploring the vaccination frontier in heart failure management. Ann Med Surg (Lond) 2024; 86:300-307. [PMID: 38222749 PMCID: PMC10783278 DOI: 10.1097/ms9.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024] Open
Abstract
Heart failure (HF) is a widespread clinical condition that affects numerous individuals globally and is a leading cause of hospitalization, particularly in the elderly population. Despite efforts to manage HF using various pharmacological and nonpharmacological interventions, mortality and hospitalization rates remain alarmingly high. Preventive vaccination has emerged as a key measure endorsed by cardiology societies for reducing the morbidity and mortality associated with HF. This study undertakes an extensive review of existing literature to explore the role of vaccination in managing HF, focusing specifically on the immunological pathways involved and potential benefits offered by immunization in this context. This article highlights the role of various vaccines, including influenza, pneumococcal, and COVID-19 vaccines, in reducing HF-related hospitalization, mortality, and overall disease burden. Additionally, this article will delve into specific vaccines that have shown promise in HF management, such as influenza, pneumococcal, and COVID-19 vaccines, along with the rationale for their use, clinical trials, meta-analyses, and real-world data supporting their effectiveness in patients with HF. This article also considers potential challenges and obstacles to widespread vaccination in individuals with HF, which include vaccine hesitancy, accessibility, and adverse events related to vaccines.
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Affiliation(s)
| | - Aysha M. Jalal
- Department of Internal Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Arshbeer S. Sandhu
- Department of Internal Medicine, Shaheed Bhai Mani Singh Civil Hospital, Bathinda, India
| | - Narendra Persad
- Department of General Surgery, Sangre Grande Hospital, Sangre Grande, Trinidad and Tobago, Caribbean
| | - Christena Satram
- Department of Surgery, Lincoln American University, Georgetown, Guyana
| | - Navya Nalajala
- Department of Geriatric Medicine, University of Arkansas for Medical Sciences, Little Rock
| | | | - Emiliano Vera
- Department of Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, Mexico
| | - Sree M. Sunkara
- Master of Public Health (MPH), University of New Haven, West Haven
| | | | - Anila Khan
- Behavioral Health Program Manager, Asia American Health Coalition dba HOPE Clinic, Houston, USA
| | - Muhammad Ehsan
- Department of Internal Medicine, Mayo Hospital, Lahore, Pakistan
| | - Sarya Swed
- Department of Medicine, Aleppo University, Aleppo, Syria
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Tanaka T, Kakiuchi S, Tashiro M, Fujita A, Ashizawa N, Eguchi S, Kenmochi T, Egawa H, Izumikawa K. Adherence to recommended vaccination policies for pre- and post-solid organ transplantation patients: A national questionnaire survey in Japan. Vaccine 2023; 41:7682-7688. [PMID: 38007343 DOI: 10.1016/j.vaccine.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Pre-transplant vaccination is recommended for patients undergoing solid organ transplantation (SOT). While appropriate vaccination protocols are implemented at some facilities, transplantation is sometimes performed with inadequate preoperative vaccine management. Vaccination rates vary across facilities, but those of SOT centers in Japan have never been investigated. This study aimed to conduct a nationwide questionnaire survey to assess pre- and post-transplant vaccination policies among SOT facilities in Japan. METHODS The survey was conducted from September to November 2022. All registered (n = 221) solid organ (namely, the lungs, liver, kidneys, pancreas, heart, and small intestine) transplant facilities were asked to complete a web-based survey. RESULTS The survey response rate was 70.2 %. Live and inactivated vaccines were recommended at 64.9 % and 68.9 % of the responding facilities, respectively. The following vaccines were incorporated into the vaccination protocols of facilities: pneumococcal vaccine, 31.7 % (13-valent pneumococcal conjugate vaccine) and 65.4 % (23-valent pneumococcal polysaccharide vaccine); hepatitis B virus vaccine, 67.3 %; severe acute respiratory syndrome coronavirus 2 vaccine, 73.1 %; influenza vaccine, 73.1 %; and zoster vaccines, 23.1 %. The reasons for unresponsiveness to vaccinations included inadequate time before transplantation (60.3 %), cost burden (41.1 %), high number of vaccinations (21.9 %), no recognition of the need for vaccination (17.9 %), and the requirement to explain the need for vaccination (15.2 %). CONCLUSIONS Our study revealed gaps in vaccination practices across nationwide facilities in Japan. The findings indicate the importance of promoting scheduled efficiency and encouraging the national health system to reduce vaccine costs with the support of public subsidies.
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Affiliation(s)
- Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
| | - Satoshi Kakiuchi
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
| | - Ayumi Fujita
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Nobuyuki Ashizawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan; Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
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Arya S, Norton N, Kaushik P, Brandtmüller A, Tsoumani E. Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature. Hum Vaccin Immunother 2023; 19:2279394. [PMID: 38014651 PMCID: PMC10760380 DOI: 10.1080/21645515.2023.2279394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
Despite widespread use of pneumococcal vaccines throughout Europe, the burden of pneumococcal disease (PD) in adults is considerable. To mitigate this burden, National Immunization Technical Advisory Groups (NITAGs) and Health Technology Assessment (HTA) agencies assess the value of different vaccine schedules for protecting against PD. The aim of this review was to assess the evidence and rationales used by NITAGs/HTA agencies, when considering recent changes to National Immunization Programs (NIPs) for adults, and how identified changes affected vaccine coverage rates (VCRs). A systematic review was conducted of published literature from PubMed® and Embase®, and gray literature from HTA/NITAG websites from the last 5 y, covering 31 European countries. Evidence related to NIP recommendations, epidemiology (invasive PD, pneumonia), health economic assessments and VCRs were collected and synthesized. Eighty-four records providing data for 26 countries were identified. Of these, eight described explicit changes to NIPs for adults in seven countries. Despite data gaps, some trends were observed; first, there appears to be a convergence of NIP recommendations in many countries toward sequential vaccination, with a pneumococcal conjugate vaccine (PCV), followed by pneumococcal polysaccharide vaccine 23. Second, reducing economic or healthcare burden were common rationales for implementing changes. Third, most health economic analyses assessing higher-valency PCVs for adults found its inclusion in NIPs cost-effective. Finally, higher coverage rates were seen in most cases where countries had expanded their NIPs to cover at-risk populations. The findings can encourage agencies to improve surveillance systems and work to reach the NIP's target populations more effectively.
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Affiliation(s)
- Stuti Arya
- Evidence Review and Synthesis, Quantify Research, Mohali, India
| | - Nicholas Norton
- Evidence Review and Synthesis, Quantify Research, Stockholm, Sweden
| | - Puneet Kaushik
- Evidence Review and Synthesis, Quantify Research, Mohali, India
| | - Agnes Brandtmüller
- Center for Observational and Real-World Evidence, MSD, Budapest, Hungary
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Stoffel ST, Schwenkglenks M, Mutschler T. General Practitioners' Awareness and Perception of Current Pneumococcal Vaccination for Adult Patients with Known Risk Factors in Switzerland: Evidence from a Survey. Vaccines (Basel) 2023; 11:1101. [PMID: 37376490 DOI: 10.3390/vaccines11061101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
In Switzerland, the National Immunization Advisory Group (NITAG) has formulated recommendations for pneumococcal vaccination among adult risk patients. Little is known about general practitioners' (GPs') perception, knowledge, and implementation of these recommendations. Therefore, we investigated GPs' awareness and drivers of and barriers to pneumococcal vaccination using a cross-sectional web-based survey of GPs. Of the 300 study participants, 81.3% were aware of the recommendations for vaccinating at-risk adult patients, but only 42.7% were aware of all risk groups. The recommendations were perceived by 79.7% as slightly to very complex. Most GPs (66.7%) had good arguments to convince patients to get vaccinated, but only 41.7% reported recognizing patients at risk for pneumococcal disease, and only 46.7% checked their patients' vaccination status and proposed vaccination if needed. The main reasons for not vaccinating were patients' refusal (80.1%), lack of reimbursement by the health insurance (34.5%), patients' fear of side effects (25.1%), and lack of regulatory approval despite the NITAG recommendations (23.7%). Most (77.3%) agreed that the treating chronic disease specialist should recommend the vaccination and 94.7% believed that adult-risk patients would not be aware of their need for pneumococcal vaccinations. Optimal implementation of the recommendations will require addressing knowledge gaps and reported barriers.
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Affiliation(s)
- Sandro Tiziano Stoffel
- Research Department of Behavioural Science and Health, UCL, London WC1E 6BT, UK
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, CH-4056 Basel, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, CH-4056 Basel, Switzerland
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Ekin T, Kış M, Güngören F, Akhan O, Atıcı A, Kunak AÜ, Mutlu D, Katkat F, Demir M, Saraç İ, Soydan E, Karabulut D, Karaduman M, Alp Ç, Bekar L, Böyük F, Adıyaman MŞ, Kaplan M, Zengin İ, Çalışkan S, Kıvrak T, Öz A, Eren H, Bayrak M, Karabulut U, Öztaş S, Düz R, Uluuysal Ö, Balun A, Sağır GN, Kudat H, Pamukçu HE, Abacıoğlu ÖÖ, Göldağ ÖG, Özmen Ç, Günay Ş, Zoghi M, Ergene AO. Awareness and Knowledge of Pneumococcal Vaccination in Cardiology Outpatient Clinics and the Impact of Physicians’ Recommendations on Vaccination Rates. Vaccines (Basel) 2023; 11:vaccines11040772. [PMID: 37112684 PMCID: PMC10142867 DOI: 10.3390/vaccines11040772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023] Open
Abstract
Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians’ recommendations on vaccination rates. Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 ± 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians’ recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25–1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15–1.92), p = 0.002] patients’ knowledge [OR = 1.93 (95% CI = 1.56–2.40), p < 0.001], and their physician’s recommendation [OR = 5.12 (95% CI = 1.92–13.68), p = 0.001]. Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates.
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Affiliation(s)
- Tuba Ekin
- Clinic of Cardiology, Sorgun State Hospital, 66700 Yozgat, Turkey
- Correspondence:
| | - Mehmet Kış
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, 35340 İzmir, Turkey
| | - Fatih Güngören
- Department of Cardiology, Faculty of Medicine, Harran University, 63000 Şanlıurfa, Turkey
| | - Onur Akhan
- Cardiology Department, Bilecik Training and Research Hospital, 11130 Bilecik, Turkey
| | - Adem Atıcı
- Cardiology Department, Faculty of Medicine, Istanbul Medeniyet University, 34722 Istanbul, Turkey
| | - Ayşegül Ülgen Kunak
- Antalya Private Medstar Topçular Hospital Cardiology Clinic, 07200 Antalya, Turkey
| | - Deniz Mutlu
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, 34452 Istanbul, Turkey
| | - Fahrettin Katkat
- Cardiology Department, Bagcilar Training and Research Hospital, University of Health Sciences, 34165 Istanbul, Turkey
| | - Mevlüt Demir
- Department of Cardiology, Faculty of Medicine, Kütahya Health Sciences University, 43270 Kütahya, Turkey
| | - İbrahim Saraç
- Department of Cardiology, University of Health Sciences, Education and Research Hospital, 25240 Erzurum, Turkey
| | - Elton Soydan
- Department of Cardiology, Faculty of Medicine, Ege University, 35100 İzmir, Turkey
| | - Dilay Karabulut
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34450 Istanbul, Turkey
| | - Medeni Karaduman
- Cardiyology Department, Van Yüzüncü Yıl Universty, 65080 Van, Turkey
| | - Çağlar Alp
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, 71450 Kırıkkale, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Corum Erol Olcok Training and Research Hospital, 19040 Corum, Turkey
| | - Ferit Böyük
- Department of Cardiology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, 34020 Istanbul, Turkey
| | - Mehmet Şahin Adıyaman
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, 21010 Diyarbakır, Turkey
| | - Mehmet Kaplan
- Department of Cardiology, Gaziantep University School of Medicine, 27310 Gaziantep, Turkey
| | - İsmet Zengin
- Department of Cardiology, Bursa City Hospital, 16110 Bursa, Turkey
| | - Serhat Çalışkan
- Department of Cardiology, Bahçelievler State Hospital, 34476 İstanbul, Turkey
| | - Tarık Kıvrak
- Department of Cardiology, Faculty of Medicine, Elazığ Fırat University, 23119 Elazığ, Turkey
| | - Ahmet Öz
- Department of Cardiology, İstanbul Training and Research Hospital, University of Health Sciences, 34098 İstanbul, Turkey
| | - Hayati Eren
- Department of Cardiology, Elbistan State Hospital, 46300 Kahramanmaraş, Turkey
| | - Murat Bayrak
- Antalya Kepez State Hospital Cardiology Clinic, 07320 Kepez, Turkey
| | - Umut Karabulut
- Department of Cardiology, İstanbul Acıbadem International Hospital, 34149 İstanbul, Turkey
| | - Selvi Öztaş
- Department of Cardiology, Bursa City Hospital, 16110 Bursa, Turkey
| | - Ramazan Düz
- Cardiyology Department, Van Yüzüncü Yıl Universty, 65080 Van, Turkey
| | - Ömer Uluuysal
- Department of Cardiology, Uludağ University, 16059 Bursa, Turkey
| | - Ahmet Balun
- Department of Cardiology, Bandırma Onyedi Eylul University, 10200 Balıkesir, Turkey
| | - Gurur Nar Sağır
- Cardiology Department, Bagcilar Training and Research Hospital, University of Health Sciences, 34165 Istanbul, Turkey
| | - Hasan Kudat
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, 34452 Istanbul, Turkey
| | - Hilal Erken Pamukçu
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, 06110 Ankara, Turkey
| | - Özge Özcan Abacıoğlu
- Department of Cardiology, Adana City Training and Research Hospital, 01120 Adana, Turkey
| | - Ömer Görkem Göldağ
- Department of Cardiology, Training and Research Hospital, 07400 Alanya, Turkey
| | - Çağlar Özmen
- Department of Cardiology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Şeyda Günay
- Department of Cardiology, Uludağ University, 16059 Bursa, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Faculty of Medicine, Ege University, 35100 İzmir, Turkey
| | - Asım Oktay Ergene
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, 35340 İzmir, Turkey
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Krasselt M, Wagner U, Seifert O. Influenza, Pneumococcal and Herpes Zoster Vaccination Rates in Patients with Autoimmune Inflammatory Rheumatic Diseases. Vaccines (Basel) 2023; 11:vaccines11040760. [PMID: 37112672 PMCID: PMC10146832 DOI: 10.3390/vaccines11040760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
Background: Vaccination rates are known to be low in patients with autoimmune inflammatory rheumatic diseases (AIIRD). We therefore aimed to determine current vaccination rates against influenza, Streptococcus pneumoniae and herpes zoster in a cohort of patients with AIIRD in Germany. Methods: Consecutive adult patients with an AIIRD were recruited from our outpatient clinic during their regular consultations. The individual vaccination status regarding influenza, Streptococcus pneumoniae and herpes zoster was obtained by reviewing the vaccination documents. Results: A total of 222 AIIRD patients (mean age 62.9 ± 13.9 years) were included. In total, 68.5% were vaccinated against influenza, 34.7% against Streptococcus pneumoniae and 13.1% against herpes zoster (HZ). The pneumococcal vaccination was outdated in 29.4% of the vaccinated patients. Vaccination rates were significantly higher in patients ≥60 years old (odds ratio (OR) 2.167, 95% confidence interval (CI) 1.213–3.870, p = 0.008 for influenza, OR 4.639, 95% CI 2.555–8.422, p < 0.0001 for pneumococcal and OR 6.059, 95% CI 1.772–20.712, p = 0.001 for HZ vaccination). Ages > 60 years, female sex, glucocorticoid use and influenza vaccination were all independently associated with a pneumococcal vaccination. Regarding influenza vaccination, only a positive pneumococcal vaccination history remained independently associated. In patients with HZ vaccination, glucocorticoid use and a preceding pneumococcal vaccination were independently associated with HZ protection. Conclusions: The frequencies of vaccinations against influenza, Streptococcus pneumoniae and HZ have increased during recent years. While this can be partly explained by continuous efforts in patient education during the outpatient visits, the COVID-19 pandemic might also have contributed. Nevertheless, the persistently high incidence and mortality of these preventable diseases in patients with AIIRDs mandates further efforts to increase vaccination coverage, particularly in SLE patients.
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Affiliation(s)
- Marco Krasselt
- Correspondence: ; Tel.: +49-341-97-24710; Fax: +49-341-97-24709
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Ghiani M, Hagemann C, Friedrich J, Maywald U, Wilke T, von Eiff C, Malerczyk C. Can risk area designation help increase vaccination coverage for Tick-Borne Encephalitis? Evidence from German claims data. Vaccine 2022; 40:7335-7342. [PMID: 36347722 DOI: 10.1016/j.vaccine.2022.10.075] [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: 07/15/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Although vaccine preventable, the incidence of tick-borne encephalitis (TBE) increased in Germany from 2001 to 2021 by on average 2% each year, with a peak of more than 700 TBE infections documented in 2020. TBE-risk areas, as designated by district based on incidence of human cases, expanded north- and northeastward, present in 11 of the 16 Federal States as of 2022. Using claims data from a German statutory health insurance in the Federal States of Saxony and Thuringia (AOK PLUS), we aimed to assess whether official assignment of a district to a risk area had an impact on vaccination rates in Germany. METHODS The data covered the period from 01/01/2010 to 31/12/2018 and included information on vaccine administrations from outpatient physicians. Yearly incident vaccination rates were reported overall and by district. To investigate the association between a new designation of an incident TBE-risk area and vaccination rates, a difference-in-difference analysis was conducted. RESULTS Overall, the incident vaccination rates increased from 6.2 to 9.5 per 1,000 person-years between 2012 and 2018, with a peak of 12.2 in 2015. While districts that had been risk-areas for the whole study period had always a higher vaccination rate compared to districts that were never categorized as risk areas, the increase between 2012 and 2018 was comparable in the two groups (3.0 and 3.2 per 1,000 person-years, respectively). In contrast, districts that were newly designated risk districts during the study period experienced a significantly larger increase in vaccination rates, going from 5.8 to 14.7 per 1,000 person-years between 2012 and 2018, with a peak of 19.6 in 2015. CONCLUSION The results suggest that the new designation of a district as risk area has a significant positive impact on vaccination rates, which is strongest immediately after designation of risk area.
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Affiliation(s)
- M Ghiani
- IPAM e.V, Alter Holzhafen 19, 23966 Wismar, Germany.
| | - C Hagemann
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | - J Friedrich
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | | | - T Wilke
- Ingress-Health HWM GmbH, Wismar, Germany
| | - C von Eiff
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
| | - C Malerczyk
- Pfizer Pharma GmbH, Linkstr. 10, 10785 Berlin, Germany
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Clinical and economic burden of pneumococcal disease among individuals aged 16 years and older in Germany. Epidemiol Infect 2022; 150:e204. [PMID: 36345842 PMCID: PMC9987016 DOI: 10.1017/s0950268822001182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study assessed the incidence rate of all-cause pneumonia (ACP) and invasive pneumococcal disease (IPD) and associated medical costs among individuals aged ≥16 in the German InGef database from 2016 to 2019. Incidence rate was expressed as the number of episodes per 100 000 person-years (PY). Healthcare resource utilisation was investigated by age group and by risk group (healthy, at-risk, high-risk). Direct medical costs per ACP/IPD episode were estimated as the total costs of all inpatient and outpatient visits. The overall incidence rate of ACP was 1345 (95% CI 1339-1352) and 8.25 (95% CI 7.76-8.77) per 100 000 PY for IPD. For both ACP and IPD, incidence rates increased with age and were higher in the high-risk and at-risk groups, in comparison to the healthy group. ACP inpatient admission rate increased with age but remained steady across age-groups for IPD. The mean direct medical costs per episode were €8075 (95% CI 7121-9028) for IPD and €1454 (95% CI 1426-1482) for ACP. The aggregate direct medical costs for IPD and ACP episodes were estimated to be €8.5 million and €248.9 million respectively. The clinical and economic burden of IPD and ACP among German adults is substantial regardless of age.
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Deb A, Podmore B, Barnett R, Beier D, Galetzka W, Qizilbash N, Haeckl D, Boellinger T, Johnson KD, Weiss T. Pneumococcal vaccination coverage in individuals (16-59 years) with a newly diagnosed risk condition in Germany. BMC Infect Dis 2022; 22:753. [PMID: 36171549 PMCID: PMC9517976 DOI: 10.1186/s12879-022-07736-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Despite recommendations from the German Standing Committee on Vaccination (STIKO), pneumococcal vaccination coverage remains low in vulnerable populations. This study estimated the pneumococcal vaccination coverage rate (VCR) and timing among individuals aged 16–59 years in Germany who were recommended to receive pneumococcal vaccination, according to STIKO. Methods A retrospective cohort analysis was conducted using the German InGef database. Individuals aged 16 to 59 years diagnosed with at least one “at-risk” (chronic disease) or “high-risk” (e.g., immunocompromising) condition considered to be at-risk of pneumococcal infection were identified at the time of first diagnosis, between January 1, 2016 and December 31, 2018, and followed up until December 31, 2019. The percentage of cumulative pneumococcal VCR with 95% confidence interval (CI) was reported for each calendar year of follow-up. Results There were 334,292 individuals followed for a median of 2.38 (interquartile range (IQR) 1.63–3.13) person years. For individuals aged 16–59 years diagnosed with an incident risk condition in 2016, pneumococcal VCR increased from 0.44% (95% CI 0.41–0.48) in 2016 to 1.24% (95% CI 1.18–1.30) in 2019. In 2019, VCRs were higher in individuals with high-risk conditions compared with at-risk conditions (2.24% (95% CI 2.09–2.40) vs. 0.90% (95% CI 0.85–0.96)). In 2019, VCRs were higher in individuals aged 50 to 59 years compared with individuals aged 16 to 49 years (2.25% (95% CI 2.10–2.41) vs. 0.90% (95% CI 0.84–0.96)). Similar trends were observed in individuals with newly diagnosed risk conditions identified in 2017 and in 2018. Older age, influenza vaccination and increasing number of risk conditions increased the likelihood of pneumococcal vaccination. Median time to vaccination from diagnosis of the risk condition was shorter for high-risk conditions (369.5 days (IQR 155.8–702.0)) compared to at-risk conditions (435.5 days (IQR 196.3–758.8)). Conclusion Despite recommendations from STIKO, pneumococcal vaccination coverage remains very low and with long delays in vulnerable individuals aged 16–59 in Germany. Further efforts are required to increase immunization levels and shorten time to vaccination among individuals 16–59 years of age developing conditions with higher susceptibility to pneumococcal infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07736-1.
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Affiliation(s)
| | - Bélène Podmore
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Wolfgang Galetzka
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Nawab Qizilbash
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
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10
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Galanos G, Dimitriou H, Pappas A, Perdikogianni C, Symvoulakis EK, Galanakis E, Lionis C. Vaccination coverage of patients with type 2 diabetes mellitus: Challenging issues from an outpatient secondary care setting in Greece. Front Public Health 2022; 10:921243. [PMID: 35979460 PMCID: PMC9376377 DOI: 10.3389/fpubh.2022.921243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023] Open
Abstract
Background Increased morbidity/mortality due to vaccine preventable diseases (VPD) is encountered in type 2 diabetes (T2D) people. Aim of this study was to assess their vaccination coverage and describe trends possibly affecting compliance. Methods Information on vaccination coverage was retrieved from either documents or interview provided by patients, and/or their vaccination record card at a specialized outpatient diabetes center. The selection of the patients was arbitrary. Results An increasing vaccination rate for influenza was observed from 2018 to 2020 among 372 participants. The vaccination coverage for S.pneumoniae was 67.2% (PCV13), 20.4% (PPSV23), 26.3% for herpes zoster in individuals ≥60 years, 1.9% for tetanus-diphtheria-pertussis and 1.1% for hepatitis B. A 10.2% of participants were found to be unvaccinated. Vaccination uptake for influenza and PCV13 was related to age, ≥3 comorbidities and long-term follow-up. T2D individuals consecutively vaccinated for influenza were 3.78 times more likely to be also vaccinated with PCV13. Conclusions Vaccination rates of patients with T2D show an increasing trend, especially for influenza and S. pneumoniae, although the one for S. pneumoniae was low. Older people seem more prone to vaccination, the one for herpes zoster was low with infected patients remaining unvaccinated while significantly low coverage was observed for other VPDs. The findings are important to improve effectiveness of preventative services.
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Affiliation(s)
- Georgios Galanos
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Health Center of Arkalohori, 7th Health District of Crete, Crete, Greece
| | - Helen Dimitriou
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Laboratory of Child Health, School of Medicine, University of Crete, Heraklion, Greece,*Correspondence: Helen Dimitriou
| | - Angelos Pappas
- Diabetic Center, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Chrysoula Perdikogianni
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Department of Pediatrics, University Hospital, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Galanakis
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Department of Pediatrics, University Hospital, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Postgraduate Program “Vaccines and Prevention of Infectious Diseases,” School of Medicine, University of Crete, Heraklion, Greece,Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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11
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Sprenger R, Häckl D, Kossack N, Schiffner-Rohe J, Wohlleben J, von Eiff C. Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time. PLoS One 2022; 17:e0265433. [PMID: 35316288 PMCID: PMC8939779 DOI: 10.1371/journal.pone.0265433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background Pneumococcal vaccination is recommended by the German Standing Committee on Vaccination (STIKO) for infants, elderly 60+ years and patients at risk. In 2016, a sequential pneumococcal vaccination schedule (conjugate vaccine followed by polysaccharide vaccine 6–12 months later) supplemented this recommendation for immunocompromised patients ≥2 years of age. Previous research showed low pneumococcal vaccination rates (pnc-VR) in this vulnerable group. Moreover, no evidence is available on adherence to the newer sequential schedule. This study aimed to analyze the development of pnc-VRs in immunocompromised patients and rates of sequential vaccinations according to the STIKO recommendations. Methods Using a representative health claims database, we assigned incident immunocompromised patients ≥2 years of age to one of two successive cohorts to observe trends over time: cohort A (first diagnosis of immunocompromised condition between 01/2013 and 12/2014), and cohort B (first diagnosis between 01/ 2015 and 12/2017). Pnc-VR within two years after first diagnosis and cumulative pnc-VR was compared among both cohorts. In cohort B, we assessed sequential pnc-VR within 15 months of the first vaccination. For additional analyses, patients were stratified by age, gender and immunocompromising condition. Results Cohort A and B comprised 193,521 and 289,279 patients, respectively. Overall pnc-VR increased over time from 4.3% (cohort A; 95%-confidence interval: 4.3%-4.4%) to 6.0% (cohort B; 5.9%-6.1%), with highest pnc-VRs in men ≥60 years (11.3%: 11.1%-11.6%) and HIV patients (15.2%: 13.1%-17.4%). Cumulative pnc-VRs in cohort B were higher in any quarter following diagnosis when compared with cohort A. Overall sequential pnc-VR in cohort B was 4.0% (3.7%-4.3%), with a higher rate observed in patients aged 16–59 (6.8%: 6.0%-7.7%) vs. patients aged ≥60 years (3.1%: 2.8%-3.4%). Conclusion While some improvements were seen over time, pnc-VRs remain very low in immunocompromised patients, as did sequential vaccination rates. Current recommendations to protect immunocompromised patients from pneumococcal infections are not being sufficiently implemented.
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Affiliation(s)
| | - Dennis Häckl
- Scientific Institute for Health Economics andfig Health System Research (WIG2 GmbH), Leipzig, Germany
- University Leipzig, Leipzig, Germany
| | - Nils Kossack
- Scientific Institute for Health Economics andfig Health System Research (WIG2 GmbH), Leipzig, Germany
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12
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COVID-19 Vaccination Coverage in Patients with Rheumatic Diseases in a German Outpatient Clinic: An Observational Study. Vaccines (Basel) 2022; 10:vaccines10020253. [PMID: 35214709 PMCID: PMC8880778 DOI: 10.3390/vaccines10020253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 01/27/2023] Open
Abstract
Background: In the second year of the COVID-19 pandemic, highly effective and safe vaccines became available. Since patients with rheumatic diseases show increased susceptibility to infections and typical medications raise the risk of severe COVID-19, high vaccination coverage is of significant importance to these patients. Methods: Consecutive patients with different rheumatic diseases were asked for their vaccination status regarding COVID-19, influenza and Streptococcus pneumoniae during their routine consultations. Any reported vaccination was validated with their personal vaccination card and/or by reviewing the CovPass smartphone app. Reasons for not having a COVID-19 vaccination were documented. Results: A total of 201 patients (mean age 62.3 ± 14.1 years) were included, the majority of them (44.3%) with rheumatoid arthritis, followed by spondyloarthritis (27.4%) and connective tissue diseases (21.4%). Vaccination coverage for SARS-CoV-2 was 80.1%; 85.6% got at least the first vaccination shot. Both valid influenza and pneumococcus coverage were associated with a higher probability of SARS-CoV-2 vaccination (odds ratio (OR) 6.243, 95% confidence interval (CI) 2.637–14.783, p < 0.0001 and OR 6.372, 95% CI 2.105–19.282, p = 0.0003, respectively). The main reason for a missing SARS-CoV-2 vaccination (70%) was being sceptical about the vaccine itself (i.e., the subjective impression that the vaccine was not properly tested and fear of unwanted side effects). Conclusions: Vaccination coverage against SARS-CoV-2 is high in patients with rheumatic diseases. Nevertheless, there are unmet needs regarding vaccination education to further increase vaccination rates.
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13
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Zens KD, Baroutsou V, Fehr JS, Lang P. Pneumococcal Vaccination Coverage and Uptake Among Adults in Switzerland: A Nationwide Cross-Sectional Study of Vaccination Records. Front Public Health 2022; 9:759602. [PMID: 35174130 PMCID: PMC8841552 DOI: 10.3389/fpubh.2021.759602] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/21/2021] [Indexed: 01/18/2023] Open
Abstract
Streptococcus pneumoniae, or pneumococcus, is a common, opportunistic pathogen which can cause severe disease, particularly in adults 65+. In Switzerland, vaccination is recommended for children under 5 and for adults with health predispositions; vaccination of healthy adults 65+ is not recommended. In 2020 we conducted a nationwide, cross-sectional survey of vaccination records to evaluate pneumococcal vaccination coverage and factors affecting uptake among adults 18–85. We found that nationwide coverage was 4.5% without significant regional differences. Coverage was comparable between men and women and between those aged 18–39 (3.0%) and 40–64 (3.2%). Coverage was significantly higher among those 65–85 (9.6%). While 2.7% of individuals reporting no health predisposition were vaccinated, 14.8% with asthma or chronic pulmonary disease, 27.1% with immunosuppression, 12.9% with diabetes, 11.6% with heart, liver, or kidney disease, and 25.9% with >1 health risk were vaccinated. Adjusted odds of vaccination for all health predispositions except heart, liver, or kidney disease were significantly increased. Among unvaccinated individuals “not enough information about the topic” and “not suggested by a doctor/healthcare provider” were the major reasons for abstaining from vaccination. Respondents reporting a health predisposition were significantly less likely to report “not at increased risk due to chronic health conditions or age” as a reason for not being vaccinated (3.7% vs. 29.1%) and were more likely to report willingness to be vaccinated in the future compared to those not-at-risk (54.2% vs. 39.9%). Our results indicate that pneumococcal vaccination coverage in Switzerland is low among both individuals 65–85 and among those with predisposing health risks. It appears that at-risk individuals are aware of their increased risk, but feel they do not have enough information on the topic to seek vaccination, or have not been recommended a vaccination by their physician.
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Affiliation(s)
- Kyra D. Zens
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Viral Immunobiology, Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Vasiliki Baroutsou
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jan S. Fehr
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Hospital, University of Zurich, Zurich, Switzerland
| | - Phung Lang
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- *Correspondence: Phung Lang
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14
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Loubet P, Rouvière J, Merceron A, Launay O, Sotto A. Patients' Perception and Knowledge about Influenza and Pneumococcal Vaccination during the COVID-19 Pandemic: An Online Survey in Patients at Risk of Infections. Vaccines (Basel) 2021; 9:vaccines9111372. [PMID: 34835303 PMCID: PMC8623007 DOI: 10.3390/vaccines9111372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The objective of our study was to assess, in an at-risk population, perception and knowledge about influenza and pneumococcal vaccinations. METHODS An anonymous web-based survey was submitted to patients recruited in France, from both an Ipsos internal panel and AVNIR patient associations. The study was conducted between July and October 2020, in the context of the COVID-19 pandemic. RESULTS Overall, 2177 questionnaires from patients at risk of infection were analyzed. Almost all respondents (86%, 1869/2177) declared themselves to be favorable to vaccination. Nearly half of the patients (49%, 1069/2177) were aware of which vaccine was recommended for their specific situation. This percentage was significantly (p < 0.001) higher for members of a patient association and for people affected by multiple chronic conditions and varied according to the type of condition. Almost two-thirds of patients (1373/2177) declared having been vaccinated during the 2019/2020 influenza season, and 41% (894/2177) were certain about being up to date with the pneumococcal vaccination. The main barriers to vaccination for influenza are the fear of side effects, doubt regarding the efficacy of the vaccine and for pneumococcal vaccination, and the absence of suggestions by the healthcare professionals (HCPs), as 64% of respondents were not recommended to obtain pneumococcal vaccination. To improve vaccine coverage, information is of prime importance and GPs are recognized as the main HCP to inform about vaccination. Nearly two-thirds (62%, 1360/2177) of patients declared that the COVID-19 pandemic convinced them to have all the recommended vaccines. CONCLUSION Our study highlighted the nonoptimal vaccine coverage in at-risk populations despite a highly positive perception of vaccines and confirmed that physicians are on the front lines to suggest and recommend these vaccinations, especially in the current pandemic context, which may be used to promote other vaccines.
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Affiliation(s)
- Paul Loubet
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
- Correspondence: ; Tel.: +33-4-66-68-41-49
| | | | | | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, AP-PH, Inserm, CIC Cochin Pasteur, 75231 Paris, France;
| | - Albert Sotto
- INSERM U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Université Montpellier, 30900 Nîmes, France;
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15
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Papazoglou DD, Baretella O, Feller M, Del Giovane C, Moutzouri E, Aujesky D, Schwenkglenks M, O’Mahony D, Knol W, Dalleur O, Rodondi N, Baumgartner C. Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients. PLoS One 2021; 16:e0260112. [PMID: 34784405 PMCID: PMC8594840 DOI: 10.1371/journal.pone.0260112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population. METHODS Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models. RESULTS Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03-1.16; and PR 2.03, 95%CI 1.22-3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03-1.08; PR 1.24, 95%CI 1.16-1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001). CONCLUSION Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.
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Affiliation(s)
- Dimitrios David Papazoglou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Oliver Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Denis O’Mahony
- Department of Medicine Cork, University College Cork National University of Ireland, Munster, IE, Ireland
- Department of Geriatric Medicine Cork, Cork University Hospital Group, Munster, IE, Ireland
| | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olivia Dalleur
- Louvain Drug Research Institute, and Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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16
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Bayraktar-Ekincioglu A, Kara E, Bahap M, Cankurtaran M, Demirkan K, Unal S. Does information by pharmacists convince the public to get vaccinated for pneumococcal disease and herpes zoster? Ir J Med Sci 2021; 191:2193-2200. [PMID: 34708289 PMCID: PMC8550811 DOI: 10.1007/s11845-021-02778-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
Background Pneumococcal diseases (PN) and herpes zoster (HZ) are preventable infections in the adult population. Aims This study aimed to identify the vaccination rates at 1 year after pharmacist-led provision of information in the community. The objectives were to reveal the reasons for not being vaccinated and to determine opinions and awareness of PN and HZ vaccination among public. Methods A prospective study was conducted in five social and solidarity centres in Turkey. Participants were educated by a pharmacist about PN and HZ diseases, vaccinations and reimbursement status, respectively. All participants were followed by telephone 1 year after to determine their vaccination status. Results A total of 155 participants (72.9% male; mean age was 68.72 ± 9.04 years) were included. With respect to PN and HZ vaccines, it was found that 40% and 12.7% of participants knew about the respective vaccines. Following the pharmacist’s educational session, 52.9% and 51.6% were willing to have the respective vaccine, but only 5.7% and 0.8% respectively got vaccinated 1 year after the educational session. Perceived disease severity, provision of information by a pharmacist, and reimbursement status of the vaccines were not associated with the vaccination rates. Conclusions The public obtain information on vaccines from friends and family members, which may result in misinformation and inappropriate behaviour in vaccination. Although educational sessions provided by pharmacists did not increase the actual vaccination rates for PN and HZ, public willingness to vaccination has increased.
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Affiliation(s)
| | - Emre Kara
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Turkey
| | - Melda Bahap
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, Turkey
| | - Kutay Demirkan
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Turkey
| | - Serhat Unal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, Turkey
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Theilacker C, Sprenger R, Leverkus F, Walker J, Häckl D, von Eiff C, Schiffner-Rohe J. Population-based incidence and mortality of community-acquired pneumonia in Germany. PLoS One 2021; 16:e0253118. [PMID: 34129632 PMCID: PMC8205119 DOI: 10.1371/journal.pone.0253118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Background Little information on the current burden of community-acquired pneumonia (CAP) in adults in Germany is available. Methods We conducted a retrospective cohort study using a representative healthcare claims database of approx. 4 million adults to estimate the incidence rates (IR) and associated mortality of CAP in 2015. IR and mortality were stratified by treatment setting, age group, and risk group status. A pneumonia coded in the primary diagnosis position or in the second diagnosis position with another pneumonia-related condition coded in the primary position was used as the base cases definition for the study. Sensitivity analyses using broader and more restrictive case definitions were also performed. Results The overall IR of CAP in adults ≥18 years was 1,054 cases per 100,000 person-years of observation. In adults aged 16 to 59 years, IR for overall CAP, hospitalized CAP and outpatient CAP was 551, 96 and 466 (with a hospitalization rate of 17%). In adults aged ≥60 years, the respective IR were 2,032, 1,061 and 1,053 (with a hospitalization rate of 52%). If any pneumonia coded in the primary or secondary diagnosis position was considered for hospitalized patients, the IR increased 1.5-fold to 1,560 in the elderly ≥60 years. The incidence of CAP hospitalizations was substantially higher in adults ≥18 years with at-risk conditions and high-risk conditions (IR of 608 and 1,552, respectively), compared to adults without underlying risk conditions (IR 108). High mortality of hospitalized CAP in adults ≥18 was observed in-hospital (18.5%), at 30 days (22.9%) and at one-year (44.5%) after CAP onset. Mortality was more than double in older adults in comparison to younger patients. Conclusion CAP burden in older adults and individuals with underlying risk conditions was high. Maximizing uptake of existing vaccines for respiratory diseases may help to mitigate the disease burden, especially in times of strained healthcare resources.
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Affiliation(s)
| | | | | | - Jochen Walker
- InGef–Institute for Applied Health Research Berlin, Berlin, Germany
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18
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Froneman C, Kelleher P, José RJ. Pneumococcal Vaccination in Immunocompromised Hosts: An Update. Vaccines (Basel) 2021; 9:536. [PMID: 34063785 PMCID: PMC8223771 DOI: 10.3390/vaccines9060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
Infections with the pathogen, Streptococcus pneumoniae, are a common cause of morbidity and mortality worldwide. It particularly affects those at the extremes of age and immunocompromised individuals. Preventing pneumococcal disease is paramount in at risk individuals, and pneumococcal vaccination should be offered. Here, we discuss the role of pneumococcal vaccination in specific groups of immunocompromised hosts.
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Affiliation(s)
- Claire Froneman
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
| | - Peter Kelleher
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
- Department of Infectious Disease, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Ricardo J. José
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
- Centre for Inflammation and Tissue Repair, UCL, London WC1E 6BT, UK
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19
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Humoral Immunity to Varicella Zoster Virus in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis Compared to Healthy Controls. Vaccines (Basel) 2021; 9:vaccines9040325. [PMID: 33915820 PMCID: PMC8067210 DOI: 10.3390/vaccines9040325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Background: The prevalence of herpes zoster (HZ) is high in patients with rheumatic diseases. Systemic lupus erythematosus (SLE) doubles the risk for developing HZ. However, little is known about natural humoral immunity against varicella zoster virus (VZV) in patients with SLE. Hence, we compared VZV IgG antibody concentrations in a group of SLE patients with healthy controls and patients with rheumatoid arthritis (RA). Methods: n = 56 patients with SLE, n = 54 patients with RA, and n = 56 healthy controls were included in this study. The VZV IgG antibody concentration was measured using an enzyme-linked immunosorbent assay (ELISA). The antibody concentrations were compared between the groups. Results: Overall IgG antibody titers for VZV in SLE patients were comparable to healthy controls but higher when compared to patients with rheumatoid arthritis (p = 0.0012). In consequence, antibody levels in controls were higher than in RA patients (p = 0.0097). Stratification by age revealed highest titers among SLE patients in the fourth life decade (p = 0.03 for controls, p = 0.0008 for RA patients) whereas RA patients in their sixth decade had the lowest antibody concentration (p = 0.03 for controls, p = 0.04 for SLE patients). Regarding the individual HZ history, antibody levels of SLE patients with a positive history exceeded all other groups. Conclusions: Although humoral VZV immunity in SLE patients is comparable to healthy controls it seems to be pronounced in young SLE patients between 30 and 39. The lowest VZV IgG levels were found in RA patients. HZ seems to induce antibody production, particularly in patients with SLE. Immunological processes might contribute to VZV antibody levels in SLE patients, but further investigations are needed to substantiate this hypothesis. Even though the increased HZ prevalence seems to be independent of humoral immunity in SLE patients, reduced humoral immunity might contribute to HZ in RA patients. The available HZ subunit vaccination might be an appropriate way to reduce the HZ risk in patients with rheumatic diseases.
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20
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Krasselt M, Baerwald C, Petros S, Seifert O. Sepsis Mortality Is high in Patients With Connective Tissue Diseases Admitted to the Intensive Care Unit (ICU). J Intensive Care Med 2021; 37:401-407. [PMID: 33631998 PMCID: PMC8772250 DOI: 10.1177/0885066621996257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: Patients with connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE) have an increased risk for infections. This study investigated the outcome and characteristics of CTD patients under intensive care unit (ICU) treatment for sepsis. Methods: A single-center retrospective analysis was conducted and reviewed all patients with a CTD diagnosis admitted to the ICU of a university hospital for sepsis between 2006 and 2019. Mortality was computed and multivariate logistic regression was used to detect independent risk factors for sepsis mortality. Furthermore, the positive predictive value of ICU scores such as Sequential Organ Failure Assessment (SOFA) score was evaluated. Results: This study included 44 patients with CTD (mean age 59.8 ± 16.1 years, 68.2% females), most of them with a diagnosed SLE (61.4%) followed by systemic sclerosis (15.9%). 56.8% (n = 25) were treated with immunosuppressives and 81.8% (n = 36) received glucocorticoids. Rituximab was used in 3 patients (6.8%). The hospital mortality of septic CTD patients was high with 40.9%. It was highest among systemic sclerosis (SSc) patients (85.7%). SOFA score and diagnosis of SSc were independently associated with mortality in multivariate logistic regression (P = 0.004 and 0.03, respectively). The Simplified Acute Physiology Score II (SAPS II), SOFA and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were good predictors of sepsis mortality in the investigated cohort (SAPS II AUC 0.772, P = 0.002; SOFA AUC 0.756, P = 0.004; APACHE II AUC 0.741, P = 0.007). Conclusions: In-hospital sepsis mortality is high in CTD patients. SSc diagnoses and SOFA were independently associated with mortality. Additionally, common ICU scores were good predictors for mortality.
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Affiliation(s)
- Marco Krasselt
- Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany
- Marco Krasselt, Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig Liebigstr. 20/22, 04103 Leipzig, Germany.
| | - Christoph Baerwald
- Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany
| | - Olga Seifert
- Rheumatology, Medical Department III–Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany
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21
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Bossert J, Ludwig M, Wronski P, Koetsenruijter J, Krug K, Villalobos M, Jacob J, Walker J, Thomas M, Wensing M. Lung cancer patients' comorbidities and attendance of German ambulatory physicians in a 5-year cross-sectional study. NPJ Prim Care Respir Med 2021; 31:2. [PMID: 33510177 PMCID: PMC7844218 DOI: 10.1038/s41533-020-00214-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
The majority of lung cancer patients are diagnosed with an advanced stage IV, which has short survival time. Many lung cancer patients have comorbidities, which influence treatment and patients’ quality of life. The aim of the study is to describe comorbidities in incident lung cancer patients and explore their attendance of ambulatory care physicians in Germany. In the observed period, 13,111 persons were first diagnosed with lung cancer (1-year incidence of 36.4 per 100,000). The mean number of comorbidities over 4 quarters was 30.77 ± 13.18; mean Charlson Comorbidity Index was 6.66 ± 2.24. In Germany, ambulatory care physicians most attended were general practitioners (2.6 quarters with contact within 4 quarters). Lung cancer was diagnosed by a general practitioner in 38% of the 13,111 incident patients. The average number of ambulatory care physician contacts over 4 quarters was 35.82 ± 27.31. High numbers of comorbidities and contacts in ambulatory care are common in patients with lung cancer. Therefore, a cross-sectoral and interdisciplinary approach is required for effective, patient-centred care. This was a 5-year cross-sectoral study, based on the InGef research database, which covers anonymized health insurance data of 7.2 million individuals in Germany. Incident lung cancer patients in a 5-year period (2013–2017) were identified. Descriptive statistics were calculated for sociodemographic characteristics, comorbidities, and attendance of ambulatory care physicians.
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Affiliation(s)
- Jasmin Bossert
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Marion Ludwig
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Pamela Wronski
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Matthias Villalobos
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Josephine Jacob
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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22
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Schley K, Malerczyk C, Beier D, Schiffner-Rohe J, von Eiff C, Häckl D, Süß J. Vaccination rate and adherence of tick-borne encephalitis vaccination in Germany. Vaccine 2021; 39:830-838. [PMID: 33414049 DOI: 10.1016/j.vaccine.2020.12.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is an arboviral infection of the central nervous system. As there is no causal treatment of TBE, disease prevention by vaccination is especially important. Immunization consists of a three-dose primary vaccination schedule, followed by regular booster doses. In Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute recommends TBE vaccination for all those at high risk of contracting TBE. This includes individuals living in, traveling to and/or working in risk areas, and being exposed to ticks. To our knowledge, there are currently no reliable data on TBE vaccination rates in Germany available. METHODS This retrospective cohort study based on anonymized German health claims data was conducted to determine vaccination rates of TBE primary immunization in 2012 to 2015 by federal state, compliance with the vaccination schedule, and TBE vaccination uptake for the 2011 birth cohort. Vaccination protection rates for each federal state were simulated based on a compartmental model. RESULTS Vaccination rates of an initiated primary immunization ranged from about 3% in the southern federal states to <1% in the northern federal states. Across all federal states, compliance with the vaccination schedule decreased with each subsequent vaccination. Slightly higher TBE vaccination uptake was determined in the 2011 birth cohort, as compared to the German school entry health examination statistics in 2017. Simulated vaccination protection rates for each federal state ranged from 10% in Hamburg to 51% in Baden-Wuerttemberg. CONCLUSIONS While there was an overall low vaccination uptake and a discrepancy between areas of high vs. low TBE risk, this study also indicates a concerning decline in vaccination compliance. Vaccinating physicians should address the importance of adherence upon initiation of TBE vaccination.
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Affiliation(s)
| | | | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | | | | | | | - Jochen Süß
- BREHMS WELT - Tiere und Menschen, Dorfstraße 22, 07646 Renthendorf, Germany
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23
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Hernández-García I, Aibar-Remón C. Effectiveness of an intervention to improve the vaccination coverage against Streptococcus pneumoniae in patients with chronic kidney disease. Hum Vaccin Immunother 2021; 17:170-172. [PMID: 32429795 DOI: 10.1080/21645515.2020.1759975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Pneumococcal vaccination is recommended for chronic kidney disease (CKD) patients. We evaluated the impact of implementing a hospital vaccine consultation on their vaccination coverages. A sample was drawn from consecutive cases referred to our clinic between November 2014 and June 2018. 101 patients were analyzed: 4 had received the pneumococcal conjugated vaccine 13-valent at the time of the first appointment, whereas 93 had received it after being seen (RR (95%-CI) = 23.3 (8.88-60.85)). Moreover, 5 had received the pneumococcal polysaccharide vaccine 23-valent at the time of the first appointment, whereas 90 had received it after being seen (RR (95%-CI) = 18.0 (7.64-42.42)). Implementing a hospital-based vaccine consultation represents an effective intervention to improve pneumococcal vaccination coverage in these patients.
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Affiliation(s)
- Ignacio Hernández-García
- Department of Preventive Medicine, Lozano Blesa University Clinical Hospital of Zaragoza , Zaragoza, Spain
| | - Carlos Aibar-Remón
- Department of Preventive Medicine, Lozano Blesa University Clinical Hospital of Zaragoza , Zaragoza, Spain
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24
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Krasselt M, Baerwald C, Petros S, Seifert O. Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis. J Intensive Care Med 2020; 36:1410-1416. [PMID: 32873111 PMCID: PMC8600591 DOI: 10.1177/0885066620953768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION/BACKGROUND Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. METHODS The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. RESULTS The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). CONCLUSIONS Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.
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Affiliation(s)
- Marco Krasselt
- Rheumatology, Medical Department III-Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
| | - Christoph Baerwald
- Rheumatology, Medical Department III-Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
| | - Olga Seifert
- Rheumatology, Medical Department III-Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Liebigstr, Leipzig, Germany
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25
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Rieg S, Bechet L, Naujoks K, Hromek J, Lange B, Juzek-Küpper MF, Stete K, Müller MC, Jost I, Kern WV, Theilacker C. A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention. Open Forum Infect Dis 2020; 7:ofaa050. [PMID: 32158777 PMCID: PMC7051034 DOI: 10.1093/ofid/ofaa050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background This study evaluated the impact of a dedicated outpatient service on vaccination uptake after splenectomy and on the incidence of postsplenectomy sepsis. Methods From 2009 to 2016 at the University Hospital Freiburg (Germany), asplenic patients were referred to a dedicated outpatient service, provided with comprehensive preventive care including vaccinations, and enrolled in a prospective cohort study. The impact of the service on vaccination uptake and the occurrence of severe sepsis/septic shock was compared between patients who had splenectomy (or were asplenic) within 3 months of study entry (“early study entry”) and those who had splenectomy (or were asplenic) >3 months before study entry (“delayed study entry”). Results A total of 459 asplenic patients were enrolled, and 426 patients were followed prospectively over a median period of 2.9 years. Pneumococcal vaccine uptake within 3 months of splenectomy or first diagnosis of asplenia was 27% vs 71% among delayed study entry and early study entry patients, respectively (P < .001). Forty-four episodes of severe sepsis or septic shock occurred in study patients: 22 after study entry and 22 before study entry. Streptococcus pneumoniae was more frequent among sepsis episodes that occurred before study entry (8/22) than after study entry (1/22 episodes). For episodes occurring after study entry, only a higher Charlson comorbidity index score was significantly associated with severe sepsis/septic shock postsplenectomy. Conclusions With dedicated outpatient care, high uptake of pneumococcal vaccination postsplenectomy was achieved. Sepsis episodes were largely of nonpneumococcal etiology in patients who had received dedicated postsplenectomy care.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena Bechet
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kai Naujoks
- Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Hromek
- Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Berit Lange
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marc-Fabian Juzek-Küpper
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katarina Stete
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias C Müller
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Insa Jost
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Theilacker
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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