Epidemiología de la neumonía adquirida en la comunidad que requiere hospitalización en personas de 65 años y más. Factores de riesgo y factores asociados al reingreso

[spa] La neumonía es un proceso inflamatorio agudo del parénquima pulmonar que se manifiesta por signos y síntomas de infección respiratoria acompañados por un nuevo infiltrado en una radiografía de tórax. Cuando afecta a la población no ingresada en un hospital se denomina neumonía adquirida en la comunidad (NAC). La NAC es una causa de morbilidad y mortalidad importante que afecta especialmente a los menores de 5 años y a las personas de 65 años y más. Según datos de las Naciones Unidas, en 2017 las personas de 65 años y más representaba el 8,29% de la población mundial y Europa acumula el porcentaje más alto de personas en este grupo de edad, el 17,59%. La incidencia de la NAC en países europeos es variable. Sin embargo, la incidencia de casos aumenta con la edad en todos los países y aproximadamente el 45% de todos los casos de NAC ocurren en pacientes de 65 años o más. En España, la recomendación actual es vacunar con vacuna antineumocócica polisacarida 23 valente a las personas de 65 años y más, administrando una dosis de recuerdo al menos 5 años después de la dosis anterior si había recibido la vacuna antes de los 65 años. Se recomienda la pauta secuencial de administración de vacuna antineumocócica conjugada 13 valente y vacuna antineumocócica polisacarida 23 valente separada por un intervalo óptimo de 12 meses y mínimo de al menos 8 semanas en personas que presenten inmunodepresión. Los OBJETIVOS del estudio son: 1. Determinar los factores de riesgo asociados al reingreso hospitalario en los 30 días posteriores al alta por NAC en personas de 65 años y más. 2. Evaluar la capacidad predictiva de la mortalidad por NAC mediante la combinación del Índice de Barthel y del Índice de Severidad de la Neumonía en personas de 65 años y más hospitalizadas. 3. Determinar los factores asociados a la cobertura de vacuna antineumocócica polisacárida 23-valente en personas de 65 años y más hospitalizadas por causas no relacionadas con neumonía, enfermedad respiratoria aguda o síndrome gripal en España. 4. Estimar la efectividad de la vacunación antineumocócica polisacárida 23 valente para prevenir la hospitalización por NAC en personas de 65 años y más y para prevenir las formas graves de NAC (ingreso en UCI y muerte) en personas hospitalizadas de 65 años y más. CONCLUSIONES: En pacientes de 65 años y más hospitalizados por NAC la tasa de reingreso en los 30 días posteriores al alta fue moderada, asociándose a factores predisponentes relacionados con el tipo de atención al paciente. La evaluación combinada del Pneumonia Severity Index y del Índice de Barthel predice con mayor precisión la mortalidad que la aplicación de cada índice por separado. La cobertura de vacunación antineumocócica en las personas de 65 años y más hospitalizadas por motivos distintos a la neumonía, enfermedad respiratoria aguda o síndrome gripal es baja y deberían establecerse estrategias para aumentar dicha cobertura. La vacunación con la vacuna antineumocócica polisacarida 23 mostró una efectividad modesta para evitar la hospitalización por NAC en las personas de 65 años y más que aumentó hasta el 40,9% para prevenir ingreso a UCI o muerte. Para valorar la conveniencia de posibles cambios en las recomendaciones de vacunación de las personas de 65 años y más es fundamental mantener una vigilancia continua de los serotipos causantes de la enfermedad neumocócica en esta población.[eng] INTRODUCTION: Community-acquired pneumonia (CAP) is a frequent, potentially serious disease in people aged ≥65years and one of the leading causes of hospitalization and mortality worldwide in this age group, in whom recovery from an episode of CAP is predictive of increased mortality in subsequent years. The incidence of CAP differs between European countries due to variations in age distribution, the introduction of vaccination programs and the clinical guidelines used. However, the incidence of cases and hospitalizations increases with age in all countries. Vaccination of the elderly is an important factor in limiting the impact of pneumonia in the community. OBJECTIVES: 1. Determine factors associated with 30-day readmission in patients with CAP. 2. Assess the predictive ability of community-acquired pneumonia mortality by combining the Barthel Index and Pneumonia Severity Index in patients aged ≥65years. 3. To determine the factors associated with the 23-valent polysaccharide pneumococcal vaccine coverage in people aged ≥65years hospitalized for causes unrelated to pneumonia, acute respiratory disease or influenza-like syndrome in Spain. 4. Estimate the effect of pneumococcal polysaccharide vaccination in preventing CAP hospitalization in hospitalized subjects aged ≥65years and reducing the risk of severe and fatal outcomes in CAP hospitalized subjects aged ≥65years. CONCLUSIONS: Rehospitalisation was associated with preventable and non-preventable factors. The use of a bimodal model to assess CAP mortality (PSI+BI) provides more accurate prognostic information than the use of each index separately. Pneumococcal vaccination coverage of hospitalized elderly people is low. The elderly need to be targeted about pneumococcal vaccination and activities that encourage healthcare workers to proactively propose vaccination might be useful. PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP

Does knowing the influenza epidèmic threshold has been reached influence the performance of influenza case definitions?

Background: Disease surveillance using adequate case definitions is very important. The objective of the study was to compare the performance of influenza case definitions and influenza symptoms in the first two epidemic weeks with respect to other epidemic weeks. Methods: We analysed cases of acute respiratory infection detected by the network of sentinel primary care physicians of Catalonia for 10 seasons. We calculated the diagnostic odds ratio (DOR) and 95% confidence intervals (CI) for the first two epidemic weeks and for other epidemic weeks. Results: A total of 4,338 samples were collected in the epidemic weeks, of which 2,446 (56.4%) were positive for influenza. The most predictive case definition for laboratory-confirmed influenza was the WHO case definition for influenza-like illness (ILI) in the first two epidemic weeks (DOR 2.10; 95% CI 1.57-2.81) and in other epidemic weeks (DOR 2.31; 95% CI 1.96-2.72). The most predictive symptom was fever. After knowing that epidemic threshold had been reached, the DOR of the ILI WHO case definition in children aged <5 years and cough and fever in this group increased (190%, 170% and 213%, respectively). Conclusions: During influenza epidemics, differences in the performance of the case definition and the discriminative ability of symptoms were found according to whether it was known that the epidemic threshold had been reached or not. This suggests that sentinel physicians are stricter in selecting samples to send to the laboratory from patients who present symptoms more specific to influenza after rather than before an influenza epidemic has been declared

Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions

Objective: Hospital readmission in patients admitted for community-acquired pneumonia (CAP) is frequent in the elderly and patients with multiple comorbidities, resulting in a clinical and economic burden. The aim of this study was to determine factors associated with 30-day readmission in patients with CAP. Design: A cross-sectional study. Setting: The study was conducted in patients admitted to 20 hospitals in seven Spanish regions during two influenza seasons (2013-2014 and 2014-2015). Participants: We included patients aged ≥65 years admitted through the emergency department with a diagnosis compatible with CAP. Patients who died during the initial hospitalisation and those hospitalised more than 30 days were excluded. Finally, 1756 CAP cases were included and of these, 200 (11.39%) were readmitted. Main outcome measures: 30-day readmission. Results: Factors associated with 30-day readmission were living with a person aged 3 hospital visits during the 90 previous days (aOR 1.53, 95% CI 1.01 to 2.34), chronic respiratory failure (aOR 1.74, 95% CI 1.24 to 2.45), heart failure (aOR 1.69, 95% CI 1.21 to 2.35), chronic liver disease (aOR 2.27, 95% CI 1.20 to 4.31) and discharge to home with home healthcare (aOR 5.61, 95% CI 1.70 to 18.50). No associations were found with pneumococcal or seasonal influenza vaccination in any of the three previous seasons. Conclusions: This study shows that 11.39% of patients aged ≥65 years initially hospitalised for CAP were readmitted within 30 days after discharge. Rehospitalisation was associated with preventable and non-preventable factor

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged 65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged 65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP

Knowledge of and attitudes to influenza vaccination among community pharmacists in Catalonia (Spain). 2013-2014 season: a cross sectional study

Annual recommendations on influenza seasonal vaccination include community pharmacists, who have low vaccination coverage. The aim of this study was to investigate the relationship between influenza vaccination in community pharmacists and their knowledge of and attitudes to vaccination. An online cross-sectional survey of community pharmacists in Catalonia, Spain, was conducted between September and November 2014. Sociodemographic, professional and clinical variables, the history of influenza vaccination and knowledge of and attitudes to influenza and seasonal influenza vaccination were collected. The survey response rate was 7.33% (506 out of 6906); responses from 463 community pharmacists were included in the final analyses. Analyses were performed using multivariable logistic regression models and stepwise backward selection method for variable selection. The influenza vaccination coverage in season 2013-2014 was 25.1%. There was an association between vaccination and correct knowledge of the virus responsible for epidemics (adjusted Odds Ratio (aOR) = 1.74; 95% CI 1.03-2.95), recommending vaccination in the postpartum (aOR = 3.63; 95% CI 2.01-6.55) and concern about infecting their clients (aOR = 5.27; 95% CI 1.88-14.76). In conclusion, community pharmacists have a very low influenza vaccination coverage, are not very willing to recommend vaccination to all their customers but they are concerned about infecting their clients

The effectiveness of influenza vaccination in the elderly in Spain in two influenza seasons: a multicenter case-control study

Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case-control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22-47). VE was 51% (95% CI: 15-71) in patients without high-risk medical conditions and 30% (95% CI: 14-44) in patients with them. VE was 39% (95% CI: 20-53) in patients aged 65-79 years and 34% (95% CI: 11-51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals

Managing an online survey about influenza vaccination in primary healthcare workers

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians , nurses and pediatricians from primary healthcare teams from seven Spanish Autono mous Communities was designed. The centers were selected by simple random sampling. The su rvey remained active and accessible for 56 days and four reminders were sent. The odds ra tios (OR) and their 95% confidence intervals (CI) were calculated to assess the associati on of sociodemographic variables and responding to the survey before the s econd reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder a nd more family physici ans (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2-1.8) than nurses. The responses obtaine d in the first 24 h afte r the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders

Knowledge of and attitudes to influenza vaccination in primary health care workers in Spain, 2011-2012

Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011-2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72-6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83-3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56-3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine