Pneumococcal and Influenza Vaccination Rates in Out-Patient setting- A Quality Improvement Project

From the 2022 HVPA National Conference

Anila Hussain MD (Crozer Chester Medical Center), Christopher Capicotto DO, Swe Hlaing MD, Nadia Aslam MD, Subha Saeed MD


Influenza is one of the common causes of hospitalization in the elderly population. The Advisory Committee on Immunization Practices (ACIP) recommends routine annual influenza vaccination for adults. Streptococcus Pneumoniae causes about 40,000 deaths annually, with the leading cause of death being invasive pulmonary diseases like bacteremia and meningitis. Routine administration of pneumococcal vaccine for all adults 65 years or older is recommended by the CDC. Individuals with immunocompromising conditions including renal failure, malignancy, organ transplant, HIV, asplenia, sickle cell disease, among others between the ages of 19-64 are also recommended to get pneumococcal vaccination along with a final dose after the age of 65.


This study aims to identify the immunization practices in teaching outpatient offices and help residents learn and improve the rates by identifying patients who are at high risk of complications and preventing those by offering appropriate vaccinations.


Our study was a retrospective, cross-sectional study conducted at teaching primary care offices in Upland, PA. Patients, aged 65 and above with comorbid conditions of Diabetes Mellitus (DM), chronic lung conditions (COPD), alcohol abuse, long-term steroid use >6 months and chronic kidney disease (CKD) were included in the study. After randomizing, the total sample size was 549 patients. Patients aged <65, or healthy adults without any comorbidities, or above-mentioned diseases were excluded from the study.


Among the total sample size of 549, the mean age was 73.87 and 45.5% of patients were male and 54.5% of patients were female. The distribution of groups was DM (41.2%), COPD (32.8%), CKD (14%), Alcohol (8%), and steroid users (4%). Overall rates of immunization were 59.2% for the Influenza vaccine and 82.1% for the pneumococcal vaccine (after the age of 65). The rate of pneumococcal vaccination in these high-risk groups (when they were under 65) was 48.6%. A major reason for patients not getting the vaccination was not being offered the vaccine, though that could be false high secondary to subjective documentation by the different providers and availability of vaccines in other settings like pharmacies. Chi-Square Analysis was done and found no statistical differences between the different disease groups. Similarly, no statistical difference was found in vaccination rates between males and females.


According to the national health interview survey published by the CDC, overall pneumococcal vaccination coverage (≥1 dose) among adults aged 19–64 years at increased risk for pneumococcal disease was 23.3% in 2018 and pneumococcal vaccination coverage among adults aged >65 years was 69.0% in 2017. Similarly, as per the survey, Influenza vaccination coverage among adults aged ≥19 years with high-risk conditions was 61.0% during the 2017–18 season. The overall pneumococcal vaccination rate at our teaching outpatient practice was found to be 82.1 %, which was above the national average. Similarly, for vaccination among high-risk patients below the age of 65, our vaccination rate was 48.6%, which is above the national average of 23.3 %. Influenza vaccination rates in our patient population were 59.2%, which is close to the national average of 61%.

Clinical Implications

This project increased the awareness of immunization practices amongst residents and the faculty. It also facilitated discussion with patients, improving patient education. There is, however, room for improvement in offering influenza vaccination and providing proper education regarding the vaccine. Also, there is a need for improved documentation regarding prior vaccinations.

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