UK physicians support routine pneumococcal immunisation for elderly

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Last Updated: 2001-07-20 10:09:12 EDT (Reuters Health)

By Pat Hagan

LONDON (Reuters Health) – One out of two physicians in Scotland believes that all elderly people should be routinely immunised against potentially pneumococcal infections, survey data show.

The UK government's Department of Health currently recommends that the vaccine be given only to high-risk groups. The new poll shows many physicians believe the toll of morbidity and mortality from pneumococcal infection could be reduced if there was a national immunisation scheme for the elderly, similar to the existing flu vaccine programme.

The survey response has prompted calls for the UK government to rethink its policy on pneumococcal vaccination in the face of poor uptake, even among high-risk groups.

Officials from the Scottish Centre for Infection and Environmental Health, who carried out the poll, say that fewer than one in ten people who need the vaccine are getting it because there is no clear vaccination policy from the Government and no financial incentive for doctors to target patients.

"Previous studies have shown it is worthwhile immunising all the elderly," said centre director Dr. Ian Jones, who spearheaded the research. "After all, most if not all of the elderly are in a target group for the vaccine anyway."

Previous surveys have suggested that only 4% to 15% of those most at risk from infection actually get immunised. To find out why, researchers devised a questionnaire that was completed by 286 general practitioners and 198 hospital doctors.

The results, published in the latest edition of Communicable Disease and Public Health, showed that while most doctors knew chronically ill patients needed to be immunised and were aware of the vaccine's safety, very few had documented policies for identifying and immunising target groups.

Many also said they felt there was a lack of public awareness about the vaccine and said a campaign to educate patients was needed.

Among GPs, 47% said they thought the vaccine–which only needs to be given once every few years–should be offered to everyone over a certain age. Among hospital doctors the figure was 46%.

One clear finding from the survey was that doctors feel uptake would improve if they had a target payments system, as with childhood vaccines. "About 85% of doctors suggested financial support and incentive payments for pneumococcal vaccine could improve its use," the researchers report.

The Government has resisted routine pneumococcal immunisation of the elderly because trials have revealed extremely mixed results on the effectiveness of the current vaccine, Dr. Jones told Reuters Health. "Some trials have suggested the vaccine has 90% efficacy, others zero. Although most show there is quite a big benefit, there is a wide variation," he said.

A new conjugate vaccine–licensed for use in the UK earlier this year–has proved very effective on children, according to Dr. Jones.

Communicable Dis Public Health 2001:4;42-48

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