Pneumococcal pneumonia is the most common form of bacterial pneumonia, causing around 150,000 hospitalizations each year, and killing about 5%–7%, or 1 in 20, of those infected. The mortality rate and risk of severe infection may be even higher among adults 65 years of age and older and people with certain medical conditions or other risk factors. In addition, adults aged 18–49 with chronic lung disease are at 19.1x greater risk than healthy adults of the same age range. Pneumococcal vaccines are underutilized in eligible adults 18–64 years of age at increased risk and in adults 65 or older.

In 2021, pneumococcal vaccination coverage among adults aged 65+ was 70% and coverage among adults 18–64 at increased risk was 30%. Additionally, pneumococcal vaccination coverage is lower among Black and Latino/Hispanic adults when compared with White adults. With CDC pneumococcal recommendations having been updated in recent years, some adult patients previously vaccinated might require additional protection. Healthcare providers play an important role in driving vaccine uptake by providing a strong recommendation to eligible patients and using best practice strategies for increasing vaccine confidence.

We spoke with some top physicians who have seen firsthand the burden of pneumococcal disease and asked them to offer their best solutions. 

We consulted:

Dr. Albert Rizzo American Lung Association’s Chief Medical Officer, Dr. Albert Rizzo
Dr. David Hill Dr. David Hill, Director of Clinical Research and Pulmonary and Critical Care Physician at Waterbury Pulmonary Associates
Dr. Meredith McCormack Dr. Meredith McCormack, Associate Professor of Medicine & Medical Director, Pulmonary Function Laboratory, Pulmonary and Critical Care Medicine, Johns Hopkins University.
Dr. Julio A. Ramirez Dr. Julio A. Ramirez, Chief Scientific Officer at Norton Infectious Diseases Institute

Q: What is the burden of pneumococcal disease in adults and what do you suggest to patients who are at severe risk of infection?

Dr Hill: Pneumococcal disease is responsible for a variety of illnesses. It can cause pneumonia, meningitis, and bacterial infections, including sepsis, all of which can lead to hospitalization and/or death.

Dr Rizzo: Anyone can get pneumococcal disease, but adults with certain underlying medical conditions, such as diabetes, asthma, COPD, or other risk factors and adults 65 years or older are at the highest risk.

Dr McCormack: Pneumococcal infection is particularly dangerous for older adults, and the severity of infection can be devastating. For instance, pneumococcal pneumonia kills about 1 in 20 adults who get it. It is even worse for meningitis and bloodstream infections, which kill about 1 in 6 older individuals and 1 in 8 adults, respectively.

Q: What underlying conditions can leave your patients at increased risk for pneumococcal disease and why is it so important to protect these patients?

Dr Rizzo: Adults 19 or older with chronic health conditions, such as COPD, asthma, diabetes, and chronic heart disease, are at increased risk for pneumococcal pneumonia. Adults 65+ are at 6.1x greater risk for pneumococcal pneumonia than healthy adults aged 18–64.

Dr Ramirez: Individuals who are immunocompromised due to medical conditions (eg, HIV, cancer, transplant) or due to medical treatments (eg, corticosteroids, biologics) and certain blood disorders (eg, sickle cell) are at higher risk, as are individuals with a cochlear implant or cerebrospinal fluid (CSF) leak, as they may lead to S pneumoniae meningitis.

Dr Hill: In addition, people who smoke cigarettes or those with alcohol use disorder are at higher risk. It’s crucial that all these groups get vaccinated.

Q: When do you usually vaccinate eligible adults against pneumococcal pneumonia? Can it be administered during the fall season with flu vaccines?

Dr McCormack: Fall is a great time to check in about recommended vaccines. However, we vaccinate year-round for pneumococcal disease.

Dr Rizzo: For eligible adults, healthcare providers can administer a pneumococcal vaccine any time of the year. During fall and winter virus season, you can administer a pneumococcal vaccine during the same visit with influenza vaccination. Administer each vaccine with a separate syringe and, if feasible, at a different injection site.

Q: Can you speak to social disparities that we see when looking at the rates of pneumococcal vaccination?

Dr Rizzo: Vaccination rates in general tend to be suboptimal from a public health standpoint, and this is for multiple reasons. Certainly, the social determinants of health—income, education, systemic discrimination, healthcare access, and cultural beliefs—coupled with mistrust of science that has grown out of the pandemic years has contributed to the low rates and disparities that we see.

Dr Ramirez: Historically, marginalized, and underserved populations have often exhibited lower vaccination rates, leading to heightened risks of outbreaks and increased morbidity and mortality in these groups.

Dr Rizzo: The Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2021 report showed overall pneumococcal vaccination rates among high-risk adults continue to be suboptimal and racial disparities are evident. A lot of work needs to be done to get out trusted information and continue to advocate for equity within the social determinants of health.

Q: What challenges do you face implementing a pneumococcal pneumonia vaccination program into your practice?

Dr Rizzo: Prioritizing pneumococcal vaccination for adult patients with underlying conditions can sometimes be challenging for the busy primary care physician. Electronic records can help, but they are only as good as the reliability of the information (vaccine status, comorbidities) that is inputted. Both the technology of electronic medical records and the commitment and working knowledge of the healthcare provider’s understanding of the role of the different pneumococcal vaccines can help adult patients receive the recommended pneumococcal vaccine(s).

Dr Hill: The only major barrier in my practice is patients’ willingness to be vaccinated. There is growing mistrust of vaccines and science in general, and this is unfortunate, as the patients are hurting themselves. We are constantly educating and attempting to encourage appropriate preventive care.

Q: Do you have any advice for your fellow healthcare providers about instituting a standard of care in practice that will address barriers and optimize the delivery of pneumococcal vaccines to their patients?

Every doctor agreed that following the CDC’s SHARE model is a good place to start.

This is the essence of the SHARE approach: 

  • SHARE the reasons why pneumococcal vaccination is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors. 
  • HIGHLIGHT positive experiences with pneumococcal vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in vaccination. 
  • ADDRESS patient questions and any concerns about pneumococcal vaccines, including side effects, safety, and vaccine effectiveness, in plain and understandable language. 
  • REMIND patients that pneumococcal vaccines help protect them from pneumococcal illness and complications that can result in hospitalization or even death for some people. 
  • EXPLAIN the potential costs of getting pneumococcal infections, including potential serious health effects for the patient, time lost (such as missing work or family obligations), and financial costs.

Dr Hill: We are committed to asking patients about vaccination status at every visit. If it is not documented, we try to make sure they are able to be immunized and we encourage them to pursue getting the appropriate vaccines.

Dr McCormack: The electronic health record has helped our practice to be more systematic about tracking when patients are eligible for recommended vaccines. We have created approaches to heighten awareness at multiple points during a patient’s office visits, including signs and electronic messages. Our medical assistants, nurses, and advanced practice providers discuss vaccines with patients, so that there are multiple opportunities to share information and answer questions at each encounter.

Dr Ramirez: Work with insurance providers and consider government programs to help your patients offset costs. You can also collaborate with community leaders to promote vaccination.

Dr Rizzo: Since there is no pneumococcal infection season, this needs to be a year-round approach for pneumococcal pneumonia. You need to emphasize the importance of vaccination. Consider language like “I see you are due for a pneumococcal vaccine. This is a very important preventive measure to help keep you from developing a severe pneumococcal infection, especially since you are at an elevated risk due to your comorbidities.”

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Developed in partnership with Pfizer.

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