Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time

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 reco...

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Bibliographic Details
Published in:PloS one 2022-03, Vol.17 (3), p.e0265433-e0265433
Main Authors: Sprenger, Ralf, Häckl, Dennis, Kossack, Nils, Schiffner-Rohe, Julia, Wohlleben, Jessica, von Eiff, Christof
Format: Article
Language:English
Subjects:
Age
Aged
Bacterial pneumonia
Biology and Life Sciences
Child, Preschool
Chronic illnesses
Cohort analysis
Cohort Studies
Confidence intervals
Diagnosis
Disease
Health economics
HIV
HIV Infections
Hospitals
Human immunodeficiency virus
Humans
Immunization
Immunocompromised Host
Immunocompromised hosts
Infant
Male
Medicine and Health Sciences
People and Places
Pneumococcal Infections - epidemiology
Pneumococcal Infections - prevention & control
Pneumococcal Vaccines - therapeutic use
Pneumonia
Polysaccharides
Prevention
Retrospective Studies
Schedules
Skin cancer
Statistics
Streptococcus infections
Vaccination
Vaccines
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Summary: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. 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. 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%). 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0265433