PNEUMOCOCCAL VACCINATION IN PULMONARY OUT-PATIENT PRACTICE – HOW FAR IS THE ADHERENCE AND WHAT ARE THE CHALLENGES?

Amit S. Gupta*, Rajesh V., Jolsana Augustine, Divya R. and Melcy Cleetus

ABSTRACT

Introduction: Invasive pneumococcal disease is cited as the commonest vaccine preventable cause of mortality and accounts for major morbidity globally. Recommendations for pneumococcal vaccination is well adhered in paediatric population as opposed totheir adult counterparts, where the stress placed is much less. Global bodies like CDC propose pneumococcal vaccination as a mandatory strategy in all subjects aged above 65 years. In subjects less than 65 years, those withcertain medical comorbidities are targets to pneumococcal vaccination strategy. Aim: The aim of the current study was to evaluate the indications for pneumococcal vaccination in adult subjects attending the pulmonary medicineoutpatient clinic of a tertiary care facility and to examine the vaccine adherence rate. In those subjects who were not vaccinated as per guidelines, the reasons for non-compliance to vaccination guidelines were also studied. Materials and methods: The present study was carried out in the pulmonary medicine unit of Geetanjali Medical College and hospital, Udaipur which is a tertiary care hospital in the state of Rajasthan, India. Patients attending the pulmonary medicine outpatient clinic with various diseases over a 2 month period (July1st, 2019 to August 31st 2019) were included in the study. The demographic details of patients, primary respiratory disease and other medical comorbidities were noted. The indications to pneumococcal vaccination as per the CDC recommendations were systematically studied. Among those with indications, the actual number of subjects who underwent vaccine administration was taken down and reasons for non-compliance were recorded. Results: A total of 215 patients attended the pulmonary medicine outpatient clinic in the study period due to varying primary respiratory diseases and comorbidities. The vast majority of them had asthma, COPD or interstitial lung disease as a primary diagnosis. Of these 190 patients had one or more indications for pneumococcal vaccination as per CDC criteria. Among those who required, the vaccine was administered only in 77 subjects. The reasons for non-adherence to vaccination in these patients were variable. Lack of recommendation by the treating doctor, concerns about cost, adverse effects of vaccine and suspicion on the efficacy were identified as the major stumbling blocks. Active counselling and vaccine recommendation was found to be missing in the case records of 11 patients, probably due to overlooking on the part of medical team. Conclusions: A pneumococcal vaccination adherence rate of 41% was noted in the present study. Indications for pneumococcal vaccination were overlooked in a substantial number of patients. In a health care setting where patient has to pay out of his pocket for health expenses, concerns of cost proves to be a hindrance in implementing a successful pneumococcal vaccination protocol. Vaccine phobia and concerns about side effects also prove to be stumbling blocks.

Keywords: Pneumococcal vaccine, chronic lung diseases, adherence rate.