RESUMEN
SETTING: Patients aged ⩾ 40 years with a diagnosis of chronic obstructive pulmonary disease (COPD; codes R95, R79 and R91 in the International Classification for Primary Care) registered in primary care clinical records in the Autonomous Community of Madrid, Spain. OBJECTIVE: To assess pneumococcal vaccination coverage in patients with COPD and to analyse factors associated with vaccination uptake. DESIGN: Population-based cross-sectional study in which data were collected in September 2010. RESULTS: We found that 93,797 patients (72.0% men and 28.0% women) had COPD. Overall coverage was 65.5% (67.5% men vs. 60.4% women, P < 0.001). In patients aged 40-59 years, coverage was 19.5%, reaching 75.8% in those aged ⩾ 60 years. In patients aged <60 years, uptake was associated with a higher number of comorbidities and appropriate adherence to seasonal influenza and pandemic vaccination schedules. In patients aged ⩾ 60 years, factors associated with uptake in both sexes were older age and appropriate adherence to seasonal influenza vaccination schedules. Factors associated with uptake in men were concomitant comorbidities and pandemic vaccination. CONCLUSION: Vaccination coverage in individuals aged <60 years with COPD is less than acceptable in Madrid. Coverage was higher in men and in patients with another chronic condition.
Asunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Pautas de la Práctica en Medicina/tendencias , Enfermedad Pulmonar Obstructiva Crónica/terapia , Vacunación/tendencias , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Estudios Transversales , Femenino , Adhesión a Directriz/tendencias , Encuestas de Atención de la Salud , Humanos , Esquemas de Inmunización , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/diagnóstico , Infecciones Neumocócicas/epidemiología , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Sistema de Registros , Factores Sexuales , España/epidemiologíaRESUMEN
Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.60.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.276.9). VE with the Broome method was 44.5% (95% CI: 23.859.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.276.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.