A Japanese nationwide survey of 23-valent pneumococcal capsular polysaccharide vaccine (PPSV23) revaccination coverage rate among elderly adults aged 65 and older and physician’s attitude

Abstract

In July 2017, the Japanese Association for Infectious Diseases issued guidance for the administration of the PPSV23 revaccination. Despite increasing recognition of its protective benefits, levels of PPSV23 revaccination coverage rate in Japanese elderly population are unclear at present. Here, we report the results of a survey to know PPSV23 revaccination rates among elderly patients aged 65 and older. We asked an array of questions related to PPSV23 revaccination to Elderly adults and doctors across Japan via Web-based surveys in June 2018. The sampled population consisted of 5,085 men and women aged 65 and older. The PPSV23 revaccination coverage rate was estimated by survey questions regarded vaccination counts, intervals, and vaccine type. In addition, 400 internal medicine physicians were surveyed and asked about their reasons for recommending PPSV23 revaccination to elderly patients. In total, 1,648 elderly adults had received at least one PPSV23 dose; of these, 58 had received it at least twice (revaccination coverage rate: 3.5%). The most commonly cited justification for revaccination with PPSV23 among the surveyed physicians was that the benefits of revaccination exceed the risks of revaccination. In addition, multivariate analysis showed revaccinated status was most strongly associated with recommendations from peers (e.g. spouse, family, friends) among elderly subjects. This study reports PPSV23 revaccination coverage rate among Japanese adults aged 65 and older for the first time and concludes that the coverage rate is very low.

Drivers of and barriers to routine adult vaccination: A systematic literature review

“… 36 , 39 , 40 , 43-45 , 54 , 68 , 69 , 80 , 82 , 84 , 85 , 87 , 89-91 Eight of the studies found that recommendations from relatives had a positive influence on vaccination. 45 , 54 , 68 , 78 , 88 , 89 , 91 , 92 Conversely, five studies indicated lack of recommendation from HCPs 35 , 81 , 85 had a negative correlation with vaccination and two studies found discouragement from an HCP was the main reason for not vaccinating. 67 , 90 From the HCP perspective, three studies surveyed HCPs on providing recommendations for vaccinations; 54 , 82 , 91 among them it was found that doctors who regularly prescribed pneumococcal vaccination also encouraged revaccination 91 in Japan, where there are guidelines for HCPs to revaccinate adults aged 65 years and older.…”

“… 45 , 54 , 68 , 78 , 88 , 89 , 91 , 92 Conversely, five studies indicated lack of recommendation from HCPs 35 , 81 , 85 had a negative correlation with vaccination and two studies found discouragement from an HCP was the main reason for not vaccinating. 67 , 90 From the HCP perspective, three studies surveyed HCPs on providing recommendations for vaccinations; 54 , 82 , 91 among them it was found that doctors who regularly prescribed pneumococcal vaccination also encouraged revaccination 91 in Japan, where there are guidelines for HCPs to revaccinate adults aged 65 years and older. 93 Additionally, non-vaccination of patients was associated with providers not regularly advising vaccination (i.e., at the first visit within an accounting period) or when the provider reported neutral (as opposed to positive or negative) feelings about vaccination counseling.…”

“… 33 , 34 , 36 , 37-39 , 40 , 43–45 , 47 , 53-55 , 57 , 59 , 61 , 66–76 , 78–92 Four studies gathered data from HCPs, as opposed to individual adults. 54 , 59 , 82 , 91 Descriptive statistics for the 61 studies are shown in Figure 2 . Most studies reported determinants of influenza vaccination (n = 49), and most originated in European countries (Italy had 13 publications), through the Middle East, the Far East, and North and South America were also represented.…”

“…Regarding previous vaccination, seven studies showed that having a vaccine record and/or previous vaccination had a positive association with vaccination in the future against the same or a different vaccine-preventable disease. 33 , 34 , 75 , 79 , 80 , 87 , 91 In two studies conducted in the United States and China, individuals with previous pneumococcal vaccination presented higher influenza vaccination coverage rates than those without. 72 , 74 A study in the Netherlands showed that vaccination in the previous year had the strongest impact on predicting influenza vaccination uptake 83 Among studies of attitudes toward vaccination, results showed that willingness or intent to receive the influenza vaccine, or a generally positive/confident attitude toward vaccination, was positively associated with vaccination against influenza, 45 , 68 herpes zoster, 43 , 71 and pneumococcus.…”

Burden of illness associated with pneumococcal infections in Japan - a targeted literature review

“…Under the National Immunization Program, the coverage rates of PPV23 vaccine for the elderly were reported as 32–38% after 2014 and PCV13 vaccine for children as 95–100% (after 2013) [ 66 ]. Another study reported the coverage of PPV23 and PCV13 vaccines for elderly in 2018 as 32% and 0.7%, respectively [ 67 ]. Also, of note, case definition of IPD has changed in November 2016 with the addition of the detection of bacteria from other sterile sites other than blood and spinal fluid to the notification criteria.…”