Diverse Interventions Found to Increase Pneumococcal Vaccine Uptake Among Older Adults in Primary Care Settings

A variety of health interventions, including basic educational materials, provider prompts, and system-wide transformation strategies, were found to effectively heighten uptake of pneumococcal vaccination among older adults in primary care settings, according to findings from a comprehensive systematic review published in Cureus.¹

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Barriers Prevent Optimal Pneumococcal Vaccine Uptake Among Older Adults

Pneumococcal infection remains a critical public concern, especially among older adults, who are disproportionately impacted by the disease. Individuals aged 65 years and older are at a significantly higher risk of various invasive pneumococcal diseases (IPD) due to the presence of underlying comorbidities and decline in immune function. Ultimately, pneumococcal infections can induce sustained declines in functionality in this population, leading to reduced independence and frailty.^2,3

Vaccination with a pneumococcal conjugate vaccine (PCV) is the most effective protection against IPD. Available PCVs, including the 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13; Wyeth Pharmaceuticals), can effectively reduce hospitalizations due to IPD. As novel PCVs are developed and recommended, including 15-valent, 20-valent, and 21-valent PCVs, it is imperative that adults at risk receive updated vaccinations. However, older adults consistently report barriers to receiving such vaccinations, and pharmacists have reported key obstacles to ensuring effective vaccination strategies in their practices.^4,5

Most concerningly, pharmacists have expressed limited knowledge of pneumococcal vaccination guidelines and report a major lack of resources to properly educate patients on the benefits of vaccination. Primary care settings are a pivotal area where older adults can receive PCV education, promotion, and vaccination, and pharmacists in this setting play an important role in encouraging uptake. The investigators of this trial aimed to conduct a comprehensive review of available evidence on strategies to improve PCV uptake in primary care among older adults, ultimately improving their health outcomes and quality of life.^1,5

Review Finds Diverse Interventions Effectively Increase PCV Coverage

Randomized controlled trials, quasi-experimental studies, and observational studies that assessed the effectiveness of interventions aimed at improving pneumococcal vaccination uptake among older adults in primary care settings were included in the review. After a total of 166 records were identified through database searches, and following full-text review, 5 studies were included in the final systematic review.¹

Characteristics of the included studies varied, with sample sizes ranging from 433 individuals in 1 outpatient clinic to over 18,000 older adults across 25 primary care clinics. Accordingly, interventions were diverse and included patient-directed educational tools, health care provider-targeted strategies, and system-wide quality improvement programs. Furthermore, these strategies differed in their target and complexity, but all studies showed directionally positive effects favoring older adults receiving pneumococcal vaccination.¹

The investigators reviewed each strategy from the included studies. Jacobson et al investigated the efficacy of a low-literacy educational brochure, finding an odds ratio (OR) of 5.28 (95% CI, 2.80-9.93). In another trial, Dexter et al found a significant improvement utilizing a digital reminder system for inpatient physicians (OR: 68.37; 95% CI, 42.69-109.51). A nurse-delivered brief education program investigated by Chan et al led to a moderate effect (OR: 1.20; 95% CI, 1.06-1.37). Additionally, Zimmerman et al evaluated a multicomponent quality improvement program called the 4 Pillars Practice Transformation and reported an OR of 1.29 (95% CI, 1.21-1.37). Lastly, Ho et al determined that point-of-care flyers at clinic registration increased uptake of PCVs modestly (OR: 1.78; 95% CI, 1.39-2.29).¹

Overall, a random-effects meta-analysis yielded a pooled OR of 4.33 (95% CI, 2.02-9.39), suggesting that the interventions meaningfully improved pneumococcal vaccination rates among older adults. Despite this positive development, there was substantial heterogeneity observed, most likely due to differences in populations, intervention design, and health care settings.¹

“Particular attention should be paid to interventions that leverage digital health platforms, task-sharing with nurses or community health workers, and culturally adapted messaging,” the investigators wrote in their discussion. “Long-term follow-up and cost-effectiveness analyses will inform health policy and funding allocation.”¹

REFERENCES

1. Ohta R, Ryu Y, Sano C. Intervention for the increase in the uptake of pneumococcal vaccination among older patients: A systematic review and meta-analysis. Cureus. 2025;17(4):e82615. doi:10.7759/cureus.82615

2. Fletcher MA, Voijicic J, Daigle D, et al. National recommendations for adult pneumococcal vaccination in countries of the WHO regions of Americas, Africa, Eastern Mediterranean, South East Asia, and Western Pacific. Vaccine. 2024;41(26):126390. doi:10.1016/j.vaccine.2024.126390

3. Vetrano DL, Triolo F, Maggi S, et al. Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing Research Reviews. 2021;69:101351. doi:10.1016/ j.arr.2021.101351

4. Wiese AD, Griffin MR, Grijalva CG. Impact of pneumococcal conjugate vaccines on hospitalizations for pneumonia in the United States. Expert Review of Vaccines. 2019;18(4):327-341. doi: 10.1080/14760584.2019.1582337

5. Halpern L. Pharmacists face key knowledge barriers to ensuring effective pneumococcal vaccination. Pharmacy Times. Published April 10, 2025. Accessed May 23, 2025. https://www.pharmacytimes.com/view/pharmacists-face-key-knowledge-barriers-to-ensuring-effective-pneumococcal-vaccination