Elsevier

Vaccine

Volume 17, Supplement 1, 30 July 1999, Pages S91-S93
Vaccine

The additive benefits of influenza and pneumococcal vaccinations during influenza seasons among elderly persons with chronic lung disease

https://doi.org/10.1016/S0264-410X(99)00114-0Get rights and content

Abstract

Uncertainty regarding the benefits of pneumococcal vaccination may contribute to the under use of this vaccine. The present study was conducted to clarify the benefits of influenza and pneumococcal vaccinations during 3 influenza seasons among elderly persons with chronic lung disease. All elderly members of a large managed care organization with a prior diagnosis of chronic lung disease were included in a cohort that was followed over three influenza seasons (1993–1994, 1994–1995, and 1995–1996). Data obtained from the administrative data bases of the health care organization included baseline demographic and health characteristics, influenza vaccination status for each season, date of pneumococcal vaccination, and outcomes for each season including hospitalization for pneumonia and death. Cox proportional hazards regression and Poisson regression with repeated measures were used to compare the risk of outcomes among vaccinated and unvaccinated persons while controlling for covariates and confounders. During the three influenza seasons, influenza vaccination alone was associated with a 52% reduction (95% CI 18–72) in hospitalizations for pneumonia and a 70% reduction (95% CI 57–89) in death. Pneumococcal vaccination alone during the three influenza seasons was associated with a 27% reduction (95% CI 13–52) in hospitalizations for pneumonia and a 34% reduction (95% CI 6–54) in death. Both vaccinations together demonstrated additive benefits. When both vaccinations had been received, there was a 63% reduction (95% CI 29–80) in hospitalizations for pneumonia and an 81% reduction (95% CI 68–88) in death versus when neither had been received. These findings suggest pneumococcal vaccination is associated with substantial benefits for elderly persons with chronic lung disease.

Introduction

Influenza and pneumococcal diseases together are responsible for hundreds of thousands of hospitalizations, tens of thousands of deaths and billions of dollars in health care costs each year in the US.. Substantial disease burdens have also been observed in many other countries. Most of the serious complications of these diseases occur among the elderly and other people with underlying chronic medical conditions.

Among those at highest risk for developing complications from both influenza and pneumococcal diseases are elderly persons with chronic lung disease. The risk of being hospitalized with pneumonia, for example, is two to seven times higher for elderly persons with underlying chronic lung disease than for those without such conditions [1], [2], [3].

In the US, both influenza and pneumococcal vaccinations are recommended for such persons at high risk [4], [5]. Despite these recommendations, however, the vaccination rates are too low: about 35% of the elderly do not receive influenza vaccination and 55% are not immunized with the pneumococcal vaccine [6]. Inadequate vaccination rates have also been observed among people at highest risk, such as the elderly with chronic lung disease [7]. Persistent uncertainties about the benefits of vaccination may contribute to the under-use of these vaccines. We conducted this study to assess the benefits of both influenza and pneumococcal vaccinations among persons at very high risk for complications from these diseases – elderly persons with chronic lung disease.

Section snippets

Methods

This cohort study was conducted among all elderly members of a large managed care organization in the Minneapolis-St. Paul, MN (USA) area in whom chronic lung disease had been diagnosed previously. Persons were included in the cohort if they were aged 65 years or more on 1 October 1993 and if chronic lung disease had been diagnosed during the preceding 12 months. Baseline data collected on each person included age, sex, other baseline diagnoses, previous use of health care resources and whether

Results

The cohort consisted of 1898 persons. The influenza vaccination rates were 72, 74 and 75% for the three influenza seasons 1993–1994, 1994–1995 and 1995–1996, respectively. Before the first season, 44% of the people in the cohort had also received a pneumococcal vaccination; an additional 23% received pneumococcal vaccination during the outcome period. Other characteristics of the cohort are shown in Table 1.

Influenza vaccination alone was associated with a 52% reduction in the risk for

Summary

Elderly persons with chronic lung disease are at very high risk for complications of influenza and of pneumococcal diseases. In this study, we have demonstrated that both of these vaccines have substantial health benefits to offer these high-risk persons during influenza seasons and that the benefits of influenza and pneumococcal vaccinations are additive in preventing the complications of hospitalization and death associated with these diseases.

The magnitude of the benefits afforded by

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