Pneumococcal vaccination rates in immunocompromised patients-A cohort study based on claims data from more than 200,000 patients in Germany
Pneumococcal vaccination rates in immunocompromised patients-A cohort study based on claims data from more than 200,000 patients in Germany
复制标题
DOI：
10.1371/journal.pone.0220848
复制
发表时间：
2019-08-08
期刊：
影响因子：
3.7
通讯作者：
Haeckl, Dennis
中科院分区：
文献类型：
--
作者：
Schmedt, Niklas;Schiffner-Rohe, Julia;Haeckl, Dennis
背景德国疫苗接种委员会建议对婴儿、60岁以上的老年人和有明确基础疾病风险的患者进行肺炎球菌疫苗接种。本研究的目的是评估肺炎球菌疫苗接种率（pnc-VR）在某些事件的患者遗传性或获得性免疫缺陷或免疫抑制，并了解谁接种这些患者谁是特别高的风险，发展为肺炎球菌infection.MethodsWe进行了一项队列研究，患者年龄2岁或以上，根据德国索赔数据的代表性样本，2013年1月至2014年12月期间首次出现“高风险”状况。Pnc-VR计算为首次“高危”疾病发作后两年内接受任何肺炎球菌疫苗的患者比例。进一步的分析涵盖pnc-VR分层高风险的条件和地区，接种疫苗的时间，和医生专业管理的肺炎球菌vaccination.ResultsThe研究人群包括204,088事件的“高风险”患者（56%的女性）。两年内的总体pnc-VR为4.4%（95%置信区间：4.3%-4.5%）。在特定的高风险条件下，我们发现在开始免疫抑制剂治疗的基础类风湿性关节炎患者中，疫苗接种率最高，为11.5%（10.1%-13.0%），其次是HIV患者的9.9%（7.8%-12.4%）。按地区分层显示，东部的疫苗接种率（6.5%：6.0%-6.9%）略高于德国西部（4.2%：4.1-4.3%）。在接种疫苗的患者中，前两年内接种疫苗的中位时间为332.5天（Q1 142天，Q3 528天）。大多数患者（92.6%）接种了全科医生。ConclusionAlthough这些脆弱的患者最需要保护，我们的研究表明，整体pnc-VR后，第一次发作的高风险条件肺炎球菌疾病是非常低的，接种疫苗是为时已晚。为了预防高危患者患肺炎球菌病，需要进一步努力提高认识，提高肺炎球菌疫苗接种的及时性。
BackgroundThe German Committee on Vaccination recommends pneumococcal vaccination for infants, seniors 60+ years and patients at risk with defined underlying diseases. Aim of this study was to assess the pneumococcal vaccination rate (pnc-VR) in patients with certain incident inherited or acquired immunodeficiency or immunosuppression and to understand who vaccinates these patients who are particularly at high risk to develop a pneumococcal infection.MethodsWe conducted a cohort study in patients aged 2 years or older, with a first episode of a "high-risk" condition between January 2013 and December 2014 based on a representative sample of German claims data. Pnc-VR was calculated as the proportion of patients receiving any pneumococcal vaccine within two years after first episode of "high-risk" condition. Further analyses cover pnc-VR stratified by high risk conditions and region, time to vaccination, and physician specialty administering the pneumococcal vaccination.ResultsThe study population comprised 204,088 incident "high-risk" patients (56% female). The overall pnc-VR within two years was 4.4% (95%-confidence interval: 4.3%-4.5%). Within specific high-risk conditions, we found the highest vaccination rate of 11.5% (10.1%-13.0%) among patients starting immunosuppressants with underlying rheumatoid arthritis followed by 9.9% (7.8%-12.4%) in HIV patients. Stratification by region revealed a slightly higher vaccination rate in Eastern (6.5%: 6.0%-6.9%) compared to Western Germany (4.2%: 4.1-4.3%). Median time to vaccination within the first two years in vaccinated patients was 332.5 days (Q1 142 days, Q3 528 days). The majority of patients (92.6%) got vaccinated by a general practitioner.ConclusionAlthough these vulnerable patients need protection most, our study suggests that the overall pnc-VR after a first episode of a high-risk condition for pneumococcal disease is very low and vaccination is far too late. To prevent pneumococcal disease in patients at high risk, further efforts are needed to increase awareness and improve the timeliness of pneumococcal vaccination.