Pneumococcal vaccination in bronchiectasis- an area for improvement?

Patients with Bronchiectasis (BE) are “at risk” of pneumococcal disease. UK National guidelines recommend routine pneumococcal vaccination (PV) in all with respiratory disease or those 65yrs+ (1). Pneumococcal vaccination is also recommended in the BTS 2010 guidelines. Our experience is that re-vaccination advice has varied and recall programs are not routine (1). Patients unsure of their vaccination schedules may miss vaccination risking pneumococcal disease, some patients may expect re-vaccination based on prior advice. Hypothesis: Patients with bronchiectasis may not be receiving revaccination according to the current guidelines. Bronchiectasis patients are at a higher risk of pneumonia. Methods: Single-centre prospective questionnaire study of vaccination, pneumonia rates and patient knowledge of pneumococcal vaccine at a UK specialist centre for adult bronchiectasis patients. Results: Data on the first 81 patients recruited are presented. Mean age was 67yrs (M: F ratio was 29: 52). 95% received PV; only 3 patients hadn't received PV with 2 additional patients unsure of PV status. Only 6 patients (7% of cohort) reported having received written information on PV or revaccination. 28 pts were either not told revaccination schedules or could not recall being told anything. 15 patients reported being told vaccination was once per lifespan, 23 were told revaccinate every 10yrs, 12 pts were told every 5 years, remainder included yearly or 3 yearly. Only 12% reported an expected PV revaccination date. 43 patients self-reported a prior episode of pneumonia. We confirmed pneumonia from secondary care radiology in 8 patients (9.9%). Primary care records were provided in 20 of 62 requests to date. Conclusions: Self-reported and confirmed episodes of pneumonia are common in BE. Pneumococcal vaccination (PV) is frequently administered in bronchiectasis patients but patients receive limited written information and are unclear about re-vaccination. Clear guidance/Automated scheduling may help improve this. Funding: Unrestricted grant Pfizer. References: [1] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263318/Green-Book-Chapter-25-v5_2.pdf