Evaluation of vaccine uptake and opportunity of in-hospital vaccination against pneumococcus in vulnerable hospitalized patients

Abstract

Background: Pneumococcal infections are an increased cause of morbimortality worldwide. The most effective preventive strategy is adequate vaccination. The aim of this work was to evaluate the vaccination coverage and associated factors for vulnerable hospitalized patients, and the opportunity of vaccination within hospitalization. Methods: Observational study conducted on a secondary care public hospital. The sample was composed of patients admitted to an Internal Medicine service, excluding participants with terminal conditions. Descriptive and bivariate analyses using chi-square and t-tests were applied. To detect profiles of non-vaccinated patients, a dendrogram was fitted using cluster analysis techniques. Multivariable logistic regression models were designed to analyse associated factors with vaccination uptake. Vaccination was finally applied if indicated. Findings: A total of 388 patients were included. Of them, 330 (85.7 %) had indication of pneumococcal vaccination, but only 180 (54.4 %) had received any previous vaccination, and 276 with indication (83.6 %) were not correctly vaccinated. During hospitalization, 192 (49.7 %) of the admitted patients were vaccinated. Vaccination coverage was higher in patients with chronic heart failure (59.4 %) or diabetes mellitus (57.5 %) than in patients with neoplasia (50.9 %) or chronic hepatopathy (26.7 %). The main factors associated with lower vaccination coverage were sex female (OR = 1.74, 95 %CI: 1.13–2.68) and COVID-19 infection (OR = 3.50, 95 %CI: 1.36–9.01). Interpretation: Our results suggest that hospitalized patients, mostly elderly patients with high frequency of comorbidities and indication of antipneumococcal vaccine (e.g., Internal Medicine or Geriatric services), have low vaccination uptake. Therefore, hospitalization admission could be a great opportunity to increase pneumococcal vaccination coverage in patients at risk. Further studies should confirm the associations with lower coverage to optimize future vaccination strategies.