Vaccinations Don’t Eliminate Pneumonia Risk.
Children and adults in Germany with chronic medical conditions continue to have increased rates of all-cause pneumonia despite the introduction of widespread pneumococcal vaccination nearly a decade ago, a study led by researchers from the Schools of Public Health and Medicine has found.
The study, in the journal BMC Infectious Diseases, found that all-cause pneumonia rates among children and adults with “at-risk” conditions were 1.7 times the rates of their healthy counterparts. The rates for children and adults with “high-risk” conditions were 1.8 to 4.1 times the rates of healthy counterparts.
Infection with Streptococcus pneumoniae (pneumococcus) has been reported to be one of the most common causes of severe pneumonia among adults throughout Europe. While childhood immunization has led to declines in the incidence of invasive pneumococcal disease in US adults—via indirect or “herd” effects—the impact of childhood vaccination in western Europe has been more variable, the authors said.
“German children and adults with a spectrum of medical conditions . . . continue to suffer a disproportionate burden of pneumonia in the era of widespread pneumococcal vaccination,” according to the study.
In addition, the researchers found that pneumonia rates in people with two or more “at-risk” conditions, such as relatively common illnesses including asthma or chronic heart disease, were comparable or higher than rates among people with “high-risk” conditions, defined as those resulting in being immune-compromised or immunosuppressed. The authors said that further efforts were needed to understand and address the magnitude of increased risk in people with multiple at-risk conditions who were not immune-compromised.
The study also demonstrated additional evidence of an increased risk of all-cause pneumonia among adults with rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, and neuromuscular/seizure disorders—conditions that are not currently included in recommendations for vaccination, but that were recently identified as potential at-risk conditions in another study.
Data for this study were obtained from healthcare claims information representing 3.4 million people in Germany collected from 2009 to 2012. At-risk and high-risk conditions, as well as episodes of all-cause pneumonia, were identified via diagnosis, procedure, and drug codes.
The study was led by Stephen Pelton, professor of epidemiology at SPH and of pediatrics at MED, and a physician at Boston Medical Center. Co-authors included Kimberly Shea, assistant professor of epidemiology; and researchers from Xcenda, Policy Analysis Inc., and Pfizer Inc. The study was sponsored by Pfizer.