Pneumococcal vaccine in the hospital. Improved use and implications for high-risk patients

A randomized trial of a program to improve pneumococcal immunization was undertaken. Also studied were the prevalence of high-risk conditions for serious pneumococcal disease among hospital admissions and prior hospitalization of patients with pneumococcal bacteremia. During two successive winters, 56% of 1,062 medical patients were identified by admission diagnosis or age as having a high-risk condition. None had received prior vaccination. During the trial period, identifying candidates for vaccination increased immunization from two (2.1%) of 95 to ten (10.4%) of 96 in year 1 and from two (2.1%) of 96 to 19 (20%) of 95 in year 2. Among adults with pneumococcal bacteremia, 33 (54%) of 61, including 32 (64%) of 50 with high-risk conditions, had documentation of prior hospitalization within five years. A hospital-based program can increase pneumococcal immunization rates and would be directed at patients in whom serious pneumococcal disease is likely to develop.