Among a total of 500 respondents at the public health center, 370 subjects (74%) were high-risk patients indicated for pneumococcal vaccination, based on Advisory Committee on Immunization Practices (ACIP) recommendations: elderly subjects aged ≥65 years (266, 53.2%), cardiovascular disease (248, 49.6%), diabetes (72, 14.4%), connective tissue disease (39, 7.8%), chronic liver disease (7, 1.4%), chronic lung disease (3, 0.6%), malignancy (2, 0.4%) and chronic renal disease (1, 0.2%). However, only 38 (7.6%) of the 500 respondents had ever been informed of the pneumococcal vaccine, and none had been vaccinated previously. Therefore, further statistical analysis could not be undertaken. At KUGH, the annual coverage rates of pneumococcal vaccine increased from 3.39% before the hospital campaign (422 among 12460 patients) to 5.91% after the hospital campaign (744 among 12591 patients) (). Compared to the subjects of the public health center, the proportion of malignancy, diabetes and chronic liver diseases were higher in those of KUGH, while the proportions of elderly subjects and cardiovascular diseases were the opposite. Although pneumonia occurs throughout the year in Korea, the pneumococcal vaccine is usually administered during autumn (September-November). Of note, the rate of pneumococcal vaccination doubled (from 104 doses to 226 doses) in September immediately after the 2007 campaign, compared to the same period in the previous year (). When we analyzed the vaccination rate in detail according to age and underlying diseases, the increments of pneumococcal vaccine coverage rate were statistically significant in patients with either chronic lung disease or chronic renal disease (p<0.01) (). As for patients with connective tissue disease, the coverage rate was high even before the campaign; after the campaign, the rate increased from 53.8% to 62.3% (p=0.03). In comparison, vaccine coverage rates among patients with diabetes, cardiovascular disease, malignancy or chronic liver diseases were still extremely low after the campaign.
Distribution of High Risk Population and Coverage Rates of Pneumococcal Vaccination in the Pre- and Post-Campaign Periods: a Tertiary Teaching Hospital-Based Survey
Monthly number of pneumococcal vaccinations for the high risk population of a tertiary teaching hospital: a comparison between pre-campaign (May 2006-April 2007) and post-campaign (May 2007-April 2008) periods.
Fig. 2 Pneumococcal vaccine coverage rates (number of vaccinees) for the high risk population of a tertiary teaching hospital, classified according to age and chronic medical conditions; connective tissue diseases include systemic lupus erythematosus, rheumatoid (more ...)
Of the total responses from 451 KUGH outpatients, 21 insincere responses were excluded and, therefore, data from 430 outpatients were analyzed. The mean age of all respondents was 55.7±13.5 years, with the total sample including 201 (46.7%) men and 131 (30.5%) women aged ≥65 years. Among the 430 respondents, only 15 (3.5%) had received the pneumococcal vaccination. The reasons given for receiving vaccinations among the 15 vaccinees are described in . The most common reason for vaccination was "doctor's advice" (53.3%), followed by "having chronic diseases" (33.3%), "previous experience of pneumonia" (20%), "to prevent pneumonia as well as the common cold" (20%) and "recommendations from friends or relatives" (20%). As for the factors that impeded respondents who might otherwise have sought pneumococcal vaccination, more than 75% of non-vaccinees replied that "I was not informed of pneumococcal vaccine by doctors or other people" during both the pre- and post-campaign periods (). Compared to the pre-campaign period, more non-vaccinees in the post-campaign period replied that they did not receive the pneumococcal vaccine because their doctors did not advise them to get it. "No previous experience of pneumococcal vaccination" (12.5%) and "self perception of good health" (12.3%) were ranked as the third and fourth most common causes of non-vaccination, respectively.
Reasons for Pneumococcal Vaccination among the High Risk Vaccinees of a Tertiary Teaching Hospital
Interrupting Factors of Pneumococcal Vaccination among the High Risk Non-Vaccinees of a Tertiary Teaching Hospital
As for the survey of doctors, the questionnaire was distributed to 55 physicians, and the reception rate was 81.8% (n=45) in the pre-campaign period and 54.5% (n=30) in the post-campaign period. The results of the KUGH survey for doctors showed that most doctors were well aware of the indications for the pneumococcal vaccine before the campaign began (). As for barriers to recommending pneumococcal vaccination, "distrust of vaccine efficacy" was markedly decreased after the campaign (p<0.01), but "low needs (demand) from patients" and "troublesome to explain the usefulness of the pneumococcal vaccine" were still common responses. Doctors usually obtain information about vaccines at medical symposia/conferences or from colleagues. After the pneumococcal vaccine campaign, the doctors whom we surveyed were more likely to report that they had obtained information about vaccines from campaign brochures (p<0.01) and medical journals (p=0.02). The effects of mass media and information by manufacturers were minimal. As for factors that increased the frequency of prescription of the pneumococcal vaccine, doctors ranked "proven data on vaccine efficacy", "guidelines of expert associations", "advertisement via mass media by government and health departments" and "cheap cost of vaccine", in that order ().
Awareness and Perceptions of Pneumococcal Vaccine among the Physicians of a Tertiary Teaching Hospital in Pre- and Post-Campaign Periods
Doctor encouraging factors (%) for the prescription of pneumococcal vaccine at a tertiary teaching hospital (total no.=75); each doctor ranked three high priorities in sequence.