Patients may have received a pneumococcal vaccination outside the VA which would underestimate our vaccination rates. However, our pneumococcal vaccination rates are comparable to the national vaccination rate of 20.1% for high-risk adults aged 19–64 reported in the 2011 National Health P-gp inhibitor Interview Survey [54]. Due to the retrospective nature of this selleck chemicals llc study, isolates were not available and as such serotype data were not available. Data on immunosuppressant use, such as corticosteroid and chemotherapy, were not available, which are risk factors for pneumococcal
disease. Additionally, there is always the potential for misclassification when relying on ICD-9 codes; however, disease coding in the VA database has been validated for a number of conditions and is determined to be of high quality [55–58]). Moreover, we identified pneumococcal infections www.selleckchem.com/products/pci-32765.html using microbiology data rather than ICD-9 codes. Finally, the generalizability of our study is limited to the Veteran population. Conclusion We described the epidemiology of invasive and non-invasive pneumococcal disease in a large, national population of older adults, who are at the greatest risk for pneumococcal infections. We observed a concerning trend of increasing S. pneumoniae risk factors among those with serious pneumococcal infections. With the aging population and the epidemic of chronic illnesses, the burden
of pneumococcal disease is likely to rise. Efforts to improve
vaccination rates among high-risk patients may be an important strategy to mitigate increases in pneumococcal disease, however this requires further investigation. Acknowledgments The views expressed are those of the authors and do not necessarily reflect the position or policy of the United States Department of Veterans Affairs. This material is based upon work supported, in part, by the Office of Research and Development, Department of Veterans Affairs. This study was sponsored, in part, by an Advancing Science through Pfizer Initiated Research (ASPIRE) grant from Pfizer Inc. All named authors meet the ICMJE criteria for authorship GNE-0877 for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Conflict of interest Haley J. Morrill has no conflicts to disclose. Aisling R. Caffrey has received research funding from Pfizer Inc. Eunsun Noh has no conflicts to disclose. Kerry L. LaPlante has received research funding or acted as an advisor, speaker, or consultant for Cubist, Durata, Davol, Forest, Theravance, and Pfizer Inc. Compliance with ethics guidelines The study design and methods were reviewed and approved by the Institutional Review Board and Research and Development Committee of the Providence Veterans Affairs Medical Center. This article does not contain any new studies with human or animal subjects performed by any of the authors.