Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Pneumococcal Vaccination Patterns in the US

Vaccine; ePub 2018 Oct 31; Yang, Zhang, et al

Among US adults aged ≥65 years, percentages of pneumococcal vaccination series completion were low, according to a recent study. The retrospective database analysis included adults who turned 65 years between January 1, 2013, and June 30, 2017 and were continuously enrolled in the Medicare Advantage plans to June 30. Pneumococcal vaccination patterns included: PCV13-PPV23, PPV23-PCV13, or receiving PPV23 or PCV13 only. Series completion was defined as receiving PCV13-PPV23 or PPV23-PCV13 from 65 years of age to June 30, 2017, while non-completion was defined as receiving only PCV13 or only PPV23 from 65 years of age to June 30, 2017. Among the findings:

  • Study population included 224,132 adults.
  • Most received no pneumococcal vaccination (49%), while 34.3% received only 1 vaccine.
  • Series completion occurred in only 16.8% of adults.
  • Adults were significantly more likely to complete pneumococcal vaccination series if they had at least 1 physician office visit, outpatient visit, or pharmacy visit vs no visits, or received an influenza vaccination in the first year after turning 65 years.


Yang X, Zhang D, Ou W. Pneumococcal vaccination patterns among persons aged 65 years or older in the United States: A retrospective database analysis. [Published online ahead of print October 31, 2018]. Vaccine. doi:10.1016/j.vaccine.2018.10.015.


Pneumococcal disease is the most common cause of bacterial pneumonia the US. It is also one of the most common causes for bacteremia. In 2008, the national vaccination rate for pneumococcal vaccine was 60%. Healthy People 2020 sets a goal of 90% as a pneumococcal immunization rate target. With the addition of the conjugate vaccine, there will be better protection against bacteremia, more herd immunity, and hopefully fewer hospitalizations. This study may show that the addition of this new vaccine may have led to less clarity among clinicians on how to proceed with vaccination against pneumococcal disease. —John Russell, MD

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