title: Missed opportunities in antipneumococcal vaccination. Can something more be done for prevention?
abstract: BACKGROUND
  Vaccination is the most effective measure in the prevention of invasive pneumococcal disease (IPD). High-risk patients immunized during medical visits would benefit from the vaccine.
  
  
  OBJECTIVE
  To describe the IPD cases. To assess the most prevalent causative serotypes and to evaluate the missed opportunities for vaccination.
  
  
  METHODS
  This is a descriptive retrospective study of the incidence of IPD cases in Elche during 5 years. It was reviewed the vaccination status and the visits to specialized care prior to disease. It was also calculated the vaccine effectiveness with the 23-valent pneumococcal vaccine in our population.
  
  
  RESULTS
  Between 2007 and 2011 were notified 181 of IPD, the most frequent medical conditions were pneumonia and sepsis, with a mortality rate of 12%. 80% of the causative serotypes are included in the vaccine. More than the half of the cases had at least one of the risk factor for indicating the vaccination. This percentage decreases by 6.2% in cases below 65 years of age with any risk factor.
  
  
  CONCLUSIONS
  After 10 years of introducing the vaccine into the adult immunization schedule the coverage it is still low among the patients with risk factors. In our study, 75% of the cases were not vaccinated. Taking in count the vaccine effectiveness for preventing IPD, among the patients attended at the hospital by the specialist prior their IPD, it could have been prevented in the best assumption (85% vaccine effectiveness) 60 IPD cases.
authors: Servicio de Medicina Preventiva, Hospital General Universitario de Elche, Alicante, España. Electronic address: arencibia_mer@gva.es.
authors: Mercedes
authors: M
authors: Arencibia Jiménez
authors: Servicio de Medicina Preventiva, Hospital General Universitario de Elche, Alicante, España.
authors: Juan Francisco
authors: JF
authors: Navarro Gracia
authors: Servicio de Medicina Preventiva, Hospital General Universitario de Elche, Alicante, España.
authors: José Antonio
authors: JA
authors: Delgado de Los Reyes
authors: Servicio de Medicina Preventiva, Hospital General Universitario de Elche, Alicante, España.
authors: Gerardo
authors: G
authors: Pérez Torregrosa
authors: Servicio de Microbiología, Hospital General Universitario de Elche, Alicante, España.
authors: David
authors: D
authors: López Parra
authors: Servicio de Microbiología, Hospital General Universitario de Elche, Alicante, España.
authors: Pilar
authors: P
authors: López García
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004198:Disease Susceptibility; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D007115:Immunization Schedule; D015994:Incidence; D007223:Infant; D008297:Male; D008511:Medicine; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012703:Serotyping; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification; D014611:Vaccination / Q000706:statistics & numerical data*; D018074:Vaccines, Conjugate; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Immunization programs; Infección neumocócica; Pneumococcal infections; Pneumococcal vaccines; Programas de inmunización; Vacunas neumocócicas