Pneumococcal polysaccharide vaccination among adults aged 65 years and older, U.S., 1989-2008

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been recommended for all people aged ≥65 years in the U.S. since 1983; consistent surveillance for vaccine coverage has been conducted since 1989.

To assess PPSV23 vaccination coverage among adults aged ≥65 years in the U.S.

The data were analyzed from the 1989, 1991, 1993-1995, and 1997-2008 National Health Interview Surveys in 2009. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with receiving PPSV23 in 2008. Missed opportunities for vaccination were also assessed.

Among people aged ≥65 years, PPSV23 coverage increased from 14.1% in 1989 to 60.1% in 2008. On average, vaccination coverage increased by 3.5% annually during 1989-2000 compared with 1.0% during 2001-2008. In 2008, coverage was significantly higher for people aged 75-84 years (68.8%), and ≥85 years (69.0%) compared with those aged 65-74 years (52.5%). Coverage was significantly higher for non-Hispanic whites (64.3%) compared with non-Hispanic blacks (44.6%) and those with Hispanic ethnicity (36.4%). Among people aged ≥65 years who reported never receiving PPSV23, 90.6% reported at least one missed opportunity. Characteristics independently associated with increased likelihood of ever receiving PPSV23 were higher age, female, non-Hispanic white race/ethnicity, not employed, higher education level, more physician visits in the past year, hospitalized within past year, having Medicare and other supplemental health insurance, and having a chronic medical condition.

National PPSV23 coverage among people aged ≥65 years increased substantially until 2000, but the rate of increase was smaller after 2000 and coverage in 2008 remained well below the national Healthy People 2010 target of 90%. Increased efforts to avoid missed opportunities for pneumococcal vaccination are needed, especially among minority populations.