Hospital-Based Strategies to Improve Pneumococcal Vaccination Rates in the Elderly

Pneumococcal infection causes approximately 40,000 deaths in the United States each year, accounting for more deaths than any other vaccine-preventable bacterial disease [1]. The highest mortality rates occur among the elderly, in whom the case-fatality rate for pneumococcal bacteremia is approximately 30% to 40%. It is estimated that approximately half of these deaths could be prevented through vaccination [1]. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (ACIP) recommends that all persons aged 65 years and older be vaccinated against pneumococcal disease [1]. However, it is estimated that less than half of targeted adults in the United States have ever received the vaccine [2]. One strategy for improving pneumococcal immunization rates among the elderly is the implementation of pneumococcal vaccination programs in the acute care inpatient setting [3–7]. Studies have shown that approximately two thirds of persons with serious pneumococcal disease are hospitalized within the 3 to 5 years prior to their pneumococcal illness [3]. The ACIP recommends that hospitalized elderly patients receive pneumococcal vaccine before discharge as a routine standard of care [1]. Pneumococcal vaccination programs targeting high-risk hospitalized patients can lead to improved immunization coverage rates [4] and may reduce the number of cases of pneumococcal infection. This article describes a project designed to improve the immunization rates for hospitalized Medicare beneficiaries in the state of Minnesota.