PNEUMOCOCCAL VACCINATION REDUCES
MORTALITY AND COSTS IN ELDERLY

MINNEAPOLIS-- Pneumococcal vaccination of high-risk groups, including elderly patients with chronic lung disease, leads to a substantial reduction in mortality, a two-year study has shown.[1] Not only does the vaccine prevent invasive pneumococcal diseases, including bacteremia and meningitis, the study authors reported, it also reduces the incidence of other, more common types of pneumococcal disease, such as pneumonia.

These findings offer new insights about the importance of pneumococcal vaccination. Until now, data on the effectiveness of the vaccine in reducing pneumococcal disease--specifically, pneumonia--have been limited, which may explain why the vaccine remains underused in high-risk groups. In fact, although the Advisory Committee on Immunization Practices has endorsed guidelines recommending the routine use of pneumococcal vaccination in the elderly, more than 50% of this population still do not receive the vaccine.

DECREASED MORTALITY, LOWER COSTS

Kristin L. Nichol, MD, chief of medicine at the VA Medical Center in Minneapolis, and colleagues at the University of Minnesota Medical School in Minneapolis assessed the outcomes of routine pneumococcal vaccination in a group of 1,898 elderly patients with chronic lung disease. Of these patients, 1,280 received the pneumococcal vaccine; the other 618 patients served as controls.

The authors found that vaccination was associated with a 43% reduction in hospitalizations for pneumonia and a 29% reduction in mortality. Pneumococcal vaccination was also associated with direct cost savings, said the authors.

Cost savings were substantial over the two influenza seasons examined in the study. Depending on which of a number of variables and assumptions were used in the analysis of cost models, the estimated cumulative savings ranged between $113 and $512 per person vaccinated.

The reduction in mortality is especially important, the authors noted, because it suggests that pneumococcal disease may be directly or indirectly responsible for a large percentage of deaths in elderly patients with chronic lung disease. The magnitude of the reduction in mortality is comparable with similar reductions in mortality when elderly persons have received influenza vaccination, they added.

The current study also demonstrated that the benefits of pneumococcal and influenza vaccination are additive. Among those who received both vaccinations, a 72% reduction in the number of hospitalizations for pneumonia and influenza was found, and an 82% reduction in the risk of death was observed.

These findings are especially important considering that previous studies have shown increased rates of hospitalization due to pneumonia and influenza during flu seasons among patients with chronic lung disease.

--Stu Chapman

Reference
1. Nichol KL, Baken L, Wuorenma J, Nelson A. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. Arch Intern Med. 1999; 159:2437-2442.