Abstract
To date, few reports have evaluated the pneumococcal vaccination status in cirrhotic patients. No data are available for European countries. We have explored this topic and the potential independent predictors motivating lack of vaccination in Italy. Between January 1st and June 30th 2022, 1419 cirrhotic patients of any etiology were consecutively enrolled in an observational, prospective study at 8 referral centers in Italy. Adjusted odds ratios (ORs) for the association with lack of vaccination were evaluated by multiple logistic regression analysis. Overall vaccine coverage was 17.9% (8.9% in patients < 65 years of age and 27.1% in those aged ≥ 65 years; p < 0.001). Among the 1165 unvaccinated patients, 1068 (91.7%) reported lack of information regarding vaccination as the reason for not having undergone vaccination. Independent predictors associated with lack of vaccination were age < 65 years (OR 3.39, CI 95% 2.41–4.76) and a higher number of schooling years (OR 2.14, CI 95% 1.58–2.91); alcoholic etiology resulted only marginally associated (OR 1.91, CI 95% 1.03–3.52). These findings establish evidence on how pneumococcal vaccination status in Italy is largely suboptimal among cirrhotic patients. These results raise concern, considering the severe outcomes of pneumococcal infection in patients with chronic liver diseases.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The datasets generated during and/or analyzed during the current study are not publicly available due to protect human privacy, but are available from the corresponding author on reasonable request.
References
Albillos A, Lario M, Alvarez-Moh M (2014) Cirrhosis associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 61:1385–1396
Hung TH, Tseng CW, Hsieh YH et al (2013) High mortality of pneumonia in cirrhotic patients with ascites. BMC Gastroenterol 13:25
Arvaniti V, D’Amico G, Fede G et al (2010) Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 139:1246–1256
Christon L, Pappas G, Falagas ME (2007) Bacterial infection related morbidity and mortality in cirrhosis. Amer J Gastroenterol 102:1510–1517
Tandon P, Garcia-Tsao G (2008) Bacterial infections, sepsis and multiorgan failure in cirrhosis. Semin Liver Dis 28:26–42
Jain S, Self WH, Wunderink RG et al (2015) Community acquired pneumonia requiring hospitalization among adults. N Engl J Med 373:415–427
Viasus D, Garcia-Vidal C, Castellote J et al (2011) Community acquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity score. Medicine 90:110–118
Gil-Prieto R, Pascual-Garcia R, Walter S et al (2016) Risk of hospitalization due to pneumococcal disease in adults in Spain. The Corienne Study Human Vaccin Immunother 2:1900–1905
Feikin D, Schuchat A, Kolczak M et al (2000) Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am J Public Health 90:223–229
Italian Ministry of Health. National immunization plan (2017-2019) https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?id=25712021. Accessed 13 Apr
Jacobs RJ, Meyerhoff AS, Saab S (2005) Immunization needs of chronic liver disease patients seen in primary care versus specialist settings. Dig Dis Sci 50:1525–1531
Ahmmad EM, Roberts LR (2020) Quality of care in patients with cirrhosis: trends in recommended adult vaccination coverage. Mayo Clin Proc Innov Qual Outcomes 4:667–682
Gaiani S, Gramantieri L, Venturoli N et al (1997) What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy. J Hepatol 27:979–985
Chon YE, Choi EH, Song KJ et al (2012) Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis. PLoS One 7:e44930
Stroffolini T, Sagnelli E, Gaeta GB et al (2017) Characteristics of liver cirrhosis in Italy: evidence for a decreasing role of HCV aetiology. Eur J Intern Med 38:68–72
Cheruvattath R, Balan V (2007) Infectious in patients with end-stage liver disease. J Clin Gastroenterol 41:403–411
Propst-Graham KL, Preheim LC, Vander Top EA et al (2007) Cirrhosis-induced defects in innate pulmonary defenses against Steptococcus Pneumoniae. Microbiol 7:94
Mccashland TM, Preheim LC, Gentry MJ (2000) Pneumococcal vaccine response in cirrhosis and liver transplantation. J Infect Dis 181:757–760
Harmala S, Parisinos CA, Shallcross L et al (2019) Effectiveness of influenza vaccines in adults with chronic liver disease: a systematic review and meta-analysis. BMJ Open 9:031070
Aggeletopoulou I, Davoulou P, Konstantakis C et al (2017) Response to hepatitis B vaccination in patients with liver cirrhosis. Rev Med Virol 27:e1942
Leise MD, Talwalkar JA (2013) Immunizations in chronic liver disease: what should be done and what is the evidence. Curr Gastroenterol Rep 15:300–306
Author information
Authors and Affiliations
Contributions
All authors have read and approved the manuscript for publication.
Corresponding author
Ethics declarations
Ethics approval
This study was approved by the ethics committee of Casa Sollievo della Sofferenza Hospital-IRCCS-San Giovanni Rotondo, as specified in “Study design and patients.”
Consent to participate
All patients gave their written consent to participate to the study, which was carried out in conformity with the 2013 revision of the Declaration of Helsinki, as specified in “Study design and patients.”
Conflict of interest
The authors declare no competing interests.
Disclosure
Statistical analysis was performed with STATA version 16.1 (StataCorp, College Station, TX, USA).
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Stroffolini, T., Ciancio, A., Federico, A. et al. Pneumococcal vaccination status among cirrhotic patients in Italy: a neglected topic. Eur J Clin Microbiol Infect Dis 42, 945–950 (2023). https://doi.org/10.1007/s10096-023-04614-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-023-04614-9