Pneumococcal Vaccination Rates Among Patients Hospitalized for Pneumococcal Infection at a Community Teaching...

Background Historically, lower pneumococcal vaccination (PV) coverage in minority populations and those with newly diagnosed chronic medical conditions, and increased hospitalizations for pneumococcal infections at Kern Medical (KM), a teaching hospital that serves as a safety net in Bakersfield, California, we sought to identify potential missed opportunities for pneumococcal vaccination at KM. Methods This quality improvement review was conducted to evaluate the PV status of patients who were hospitalized for pneumococcal disease from January 2023 through June 2024. Eligibility for PV was based on the Centers for Disease Control and Prevention (CDC)'s 2025 adult immunization schedule. PV history was identified through the California Immunization Registry. The primary endpoint was PV coverage in patients hospitalized for pneumococcal disease. Secondary endpoints included 14-day all-cause mortality, length of stay (LOS), and opportunities for vaccination at KM prior to admission. Results Thirty-five patients were hospitalized for pneumococcal disease at KM, including 18 cases of bacteremia. The mean age was 54 years, 77% were male, and 54% were Hispanic/Latino. Twenty-five patients met CDC criteria for PV; however, 92% of these patients were unvaccinated (68%) or undervaccinated (24%). Eight patients died within 14 days of positive culture, seven of whom were unvaccinated but eligible for PV. Mean LOS was 14 days with seven ICU days. Of the 23 unvaccinated or undervaccinated patients, the most common criteria met for PV included age (70%), chronic liver disease or alcoholism (35%), and diabetes mellitus (26%); only four patients between 50-64 years met criteria based on age alone. Of these, only five had primary care encounters at KM within one year of admission. Discussion Despite significant improvement in general incidence and outcomes of pneumococcal disease due to PV, vaccination rates still lag in minority communities and those with underlying medical conditions. The resultant and potentially avoidable impact on mortality and healthcare resources should serve as a call-to-action for public health and key stakeholders, including community pharmacies, to capture and augment opportunities for vaccination in these vulnerable populations. Conclusion This quality improvement review underscores significant gaps in pneumococcal vaccination coverage among adults hospitalized with pneumococcal disease at a safety-net hospital. Despite clear eligibility, the vast majority of the patients remained unvaccinated or undervaccinated prior to admission. However, achieving meaningful improvement in vaccine uptake will require a collaborative effort by public health agencies, hospital systems, and community partners to build trust, reduce vaccine hesitancy, and implement sustainable, equity-centered vaccination initiatives.