Implementing an efficient reminder system to prompt Australians aged 65 and above to receive their free pneumococcal vaccination may be pivotal to improving the low 54 per cent vaccination rates among this at-risk population.¹

Findings from the Pneumococcal Pneumonia Vaccination General Practice Nurse survey reveal while many general practice nurses acknowledge having some sort of pneumococcal vaccination practice reminder system in place (44 per cent), the majority report either waiting for patients to present with a health concern (55 per cent), or for their annual flu shot (84 per cent), before recommending the National Immunisation Program (NIP) funded vaccine.²

Furthermore, while one-in-three Australian general practice nurses report proactively prompting their patients turning 65 to have the recommended pneumococcal vaccination, either by letter or phone, almost one-in-six report not having a system in place at all.²

According to Australian Primary Health Care Nurses Association (APNA) President, Karen Booth, the survey findings highlight the need for Australian general practice nurses to put a system in place, to remind all patients turning 65, and any patients aged 70 years and above who are living with a chronic condition that puts them at heightened risk of contracting pneumonia, to get their pneumococcal vaccination or revaccination.

“The good news is, 75 per cent of the time, general practice nurses are involved in initiating the discussion on pneumococcal vaccination,² which acknowledges their strong level of responsibility as the main point of contact for patients,” Ms Booth said.

“However, while 86 per cent of practices report most pneumococcal pneumonia vaccinations provided are for patients aged 65 and above, some practices are performing better than others in terms of vaccinating those within that age-group, with 28 per cent vaccinating more than three-quarters, 26 per cent vaccinating half to three-quarters, and, 25 per cent vaccinating less than half of those eligible,”² said Ms Booth.

Patient reminder and recall systems have proven effective in increasing vaccination rates in other countries, including Canada, particularly so in primary care settings.^3-5 Patients who received reminders about due or overdue vaccines were more likely to be immunised, or be up-to-date with vaccinations, according to national recommendations, compared to those who received no reminder.³

The Pneumococcal Pneumonia Vaccination General Practice Nurse survey, conducted by bioCSL and distributed to APNA members and their broader subscribers, also highlighted the risk of pneumococcal pneumonia is not well understood among patients aged 65 and above, with general practice nurses reporting varying levels of patient infection risk awareness between practices.²

Recent Lung Foundation Australia consumer research revealed Australian adults aged 65-to-74 years consider lifestyle factors including eating healthily (29 per cent), exercising regularly (23 per cent) and regular GP checks (21 per cent), as most important to ageing well. However, only 4 per cent of this at-risk population considers receiving vaccinations recommended for their age and health condition as most important in ageing well.⁶

“Given the gap in awareness and understanding surrounding the seriousness of pneumococcal pneumonia among the aged population and the importance of vaccination for those at-risk, the onus falls on primary healthcare professionals, including general practice nurses and GPs, to educate and encourage patients turning 65 and above, to protect against this very serious lung infection,” Ms Booth said.

University of Sydney infectious diseases and immunisation expert, Professor Robert Booy, says pneumococcal pneumonia should not be underestimated, urging primary healthcare professionals to prioritise putting a reminder system in place in their practice.

“The prevention of illness is a cornerstone of effective primary healthcare. Immunisation plays a key role, not only by protecting those vaccinated, but also the general population, by preventing the spread of infection to others at-risk,” said Prof Booy.

“Latest figures indicate the number of Australians turning 65 and above will exceed three million,⁷ yet overwhelmingly, the greater majority of Australians in this age group don’t personally consider themselves, or don’t know whether they’re at-risk of pneumonia.⁶ This is incredibly worrying, given pneumonia-like illness (pneumonia and influenza) is among the top 15 contributing causes of death in Australia.⁸

“Pneumonia is an enemy of the elderly – preventing it can give an elderly person many more years of a happy and productive life,” Prof Booy said.

The Pneumococcal Pneumonia Vaccination General Practice Nurse survey revealed only 26 per cent of respondents estimated more than half of all patients aged 65 and above have been vaccinated against pneumococcal pneumonia nationally, with most (42 per cent) estimating less than half of Australians aged 65 and above have been vaccinated, and the remaining 31 per cent admitting they were unsure of the current national vaccination rates.²

“While many respondents have been immunising Australians aged 65 and above against pneumococcal pneumonia, there’s certainly room for improvement,” Ms Booth said.

“Immunisation rates for adults aged 65 and above have remained low over the last decade so improving this figure should be a main point of focus for primary health care professionals,^1,10” said Ms Booth.

While all Australians aged 65 and above are at risk of pneumonia due to their age alone, 63 per cent of those aged 70 years and over also have a chronic condition that further elevates their risk, allowing them to access a second dose of the pneumococcal vaccine, five years after their first.⁹

The survey revealed almost 80 per cent of practices offer a second pneumococcal vaccine to all eligible patients aged over 65 years, five or more years after their previous pneumococcal vaccination.²

According to the Australian Immunisation Handbook, a single dose of the pneumococcal polysaccharide vaccine, Pneumovax23^® (Pneumococcal Vaccine Polyvalent) is recommended for all non-indigenous adults at the age of 65 years. A second dose of Pneumovax23^® is recommended at least five years after the first dose, for adults with an underlying medical condition associated with an increased risk of invasive pneumococcal disease (IPD), including people with diabetes, chronic lung, heart or liver disease.¹¹

Indigenous adults are recommended to receive a single dose of Pneumovax23^® at 50 years of age, with a second dose five years after the first.¹¹

Pneumovax23^® is the only pneumococcal vaccine funded on the NIP and subsidised on the PBS for eligible adults.

The Pneumococcal Pneumonia Vaccination General Practice Nurse was conducted between April 23 and May 22, 2015. It was designed to garner the knowledge of, and experience with, pneumococcal vaccination nationwide. A total of 122 general practice nurses were surveyed. The survey did not differentiate between indigenous and non-indigenous Australians.

References

1. AIHW 2011. 2009 Adult Vaccination Survey. Available at aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418286 [last accessed September, 2015].
2. The Pneumococcal Pneumonia Vaccination General Practice Nurse survey. Conducted by bioCSL, distributed by APNA Australia. May, 2015.
3. Jacobson Vann JC, Szilagyi P. 2009. Patient reminder and patient recall systems for improving immunization rates. The Cochrane Collaboration. John Wiley & Sons, Ltd.
4. Shefer AM et al. 1999. “Improving immunization coverage rates: an evidence-based review of the literature.” Epidemiologic Reviews; 21(1): 96-142.
5. Task Force on Community Preventive Services. 1999. “Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults.” Morbidity and Mortality Weekly Report; 48(RR-8): 1-15. www.cdc.gov/mmwr/PDF/rr/rr4808.pdf.
6. ‘Lungs4Life’ Pneumonia 2015 Conducted by Galaxy Research, commissioned by Lung Foundation of Australia. April, 2015.
7. Australian Bureau of Statistics. 3235.0 – Population by Age and Sex, Regions of Australia, 2012. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Products/3235.0~2012~Main+Features~Main+Features?OpenDocument [last accessed September, 2015].
8. Australian Bureau of Statistics. 3303.0 – Causes of Death, Australia, 2012. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0main+features100012012 [Last accessed September 2015].
9. SAND abstract number 223 from the BEACH program 2014-15. Pneumococcal vaccination in general practice patients 2014. Available at: http://sydney.edu.au/medicine/fmrc/publications/sand-abstracts/223-pneumococcal_vaccination.pdf [Last accessed September 2015].
10. AIHW 2005. 2004 Adult Vaccination Survey. Available at aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459623 [last accessed September, 2015].
11. Immunise Australia Program. The Australian Immunisation Handbook 10^th Available at http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4~handbook10-4-13 [last accessed September, 2015].