Pneumococcal vaccination among African American older adults and persons aged 18-64 years with high-risk medical conditions in a large urban academic medical center

BACKGROUND: Pneumococcal infection causes an estimated 40,000 deaths annually in the US, accounting for more deaths than any other vaccine-preventable bacterial disease with higher risk identified for African Americans and smokers. Pneumococcal vaccination rates among adults >65 years and those <65 years with high risk medical conditions are still below the Healthy People 2010 target level of 90%. In addition, racial disparities in coverage levels persist in both target populations.We sought to determine the status, barriers and facilitators of pneumococcal vaccination among AA adults seen at our large urban hospital. METHODS: A cross sectional survey of outpatient clinic attendees was conducted using a pre-tested self-administered questionnaire based on the Triandis model over a one-month period. Setting: Outpatient medical clinic of a 953-bed, inner-city, academic medical center serving a >75% AA patient population. Participants: All African American patients >65 years or 18-64 years with high-risk medical condition. Measurements: Barrier to PPV was defined as any factor hindering individualxs acceptance of PPV while facilitator was defined as any factor that will encourage acceptance of PPV. Statistical analysis: Univariate analysis of demographic, PPV barrier and facilitating factors and status were expressed as percentages,frequencies and means. Chi square and Fisherxs exact tests done to determine association of participantsx knowledge, beliefs and perceptions with their PPV status, and to compare the older with the younger population. Multivariate regression models performed to ascertain factors predicting the non-receipt of PPV among participants

RESULTS: Of the 103 participants, 44.7% were 23-49 years, 35.9 % 50-64 years, and 19.4% >65 years. Females were 59.2%. Overall, 21.4% of all participants, 19.3% of those <65 years and 30% of those >65 years had received PPV. Only 27% of participants, 26.5% of the <65s and 30% of those >65 thought they needed vaccine.Providers had ever recommended PPV for 19.3% of participants, 18% of those under 65 and 25% of those >65. Up to 75% of participants would get PPV if recommended by their provider. The commonest barrier to vaccination identified in both groups was a lack of awareness about PPV - 30% in all, 31% in those <65 and 20% in those >65

CONCLUSIONS: Lack of awareness of PPV need and low provider recommendation were the commonest barriers to vaccination among both younger and older AA adults. There might be the need for more innovative interventions to ensure improvement in the recommendation of vaccination by providers and encourage provider-led PPV counselling