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Primary Care

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Pneumonia vaccination rates remain low, and racial disparities exist

Unlike the annually recommended influenza vaccine, the pneumonia vaccine is a once (possibly twice) in a lifetime inoculation. Pneumonia vaccination is currently recommended for people who are elderly, nursing home residents, and those who are immunocompromised by HIV infection, splenic disorders, diabetes, renal failure, dialysis, alcoholism, cirrhosis of the liver, malignant diseases, or organ transplantation. Despite national goals to inoculate 90 percent of elderly adults and 60 percent of nonelderly at-risk adults against pneumonia by the year 2010, pneumonia vaccination rates remain low, and racial disparities persist, finds a study supported by the Agency for Healthcare Research and Quality (HS09874).

Researchers from the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center reviewed the research literature between 1985 and 2000 regarding physician and patient knowledge, attitudes, practices, and characteristics related to pneumococcal polysaccharide vaccine (PPV) vaccination rates. The review revealed that many doctors were unsure about who should receive the vaccine. Doctors believed the vaccine to be efficacious, safe, and clinically relevant but said that other clinical priorities competed for their attention. Also, between 42 and 57 percent of doctors said it was difficult to determine patient immunization status, and many did not agree on what to do if a patient's vaccination status was unknown.

In 1996, over half (57 percent) of eligible unvaccinated adults were not aware of the benefit of the pneumonia vaccine, and many did not remember being advised to get vaccinated by their doctor. This is important, since physician reminders, standing vaccination orders for some patients, and hospital/emergency room interventions rank among the more effective strategies for increasing PPV rates. As late as 1999, racial disparities existed in pneumonia vaccination rates. In that year, the PPV rate for whites was 57 percent compared with 36 percent for blacks and 35 percent for Hispanics.

See "Adult pneumococcal vaccination: A review of physician and patient barriers," by Drs. Mieczkowski and Wilson, in the January 2002 Vaccine 20, pp. 1383-1392.

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