PNEUMOCOCCAL AND INFLUENZA VACCINATION LEVELS AMONG HIV-INFECTED ADOLESCENTS AND ADULTS RECEIVING MEDICAL-CARE IN THE UNITED-STATES

Objective: To assess pneumococcal and influenza vaccination coverage among HIV-infected adolescents and adults receiving medical care in the United States. Design: Periodic medical record reviews. Setting: More than 90 clinics, hospitals, and private medical practices in nine cities. Patients: HIV-infected individuals aged greater than or equal to 13 years were included in the analyses of pneumococcal (n = 9737) and influenza (n = 6161) vaccination coverage. Main outcome measures: Documentation of receipt of pneumococcal and influenza vaccines in medical records during 6-18-month and 12-month periods, respectively. Results: Overall, 37 and 33% of individuals received pneumococcal and influenza vaccines, respectively. In general, vaccination levels varied little by age group, race/ethnicity, or mode of HIV exposure. Having had at least five medical visits was significantly associated with having received pneumococcal and influenza vaccines [adjusted odds ratio (OR), 1.7 for each]. Having a CD4+ T-lymphocyte count < 200 x 10(6)/l (adjusted OR, 0.8) and being female (adjusted OR, 0.7) were associated with non-receipt of pneumococcal vaccine. Lower pneumococcal vaccination coverage among women was mostly accounted for by pregnancy. Conclusion: Until new, more effective means of preventing pneumococcal disease and influenza become available, efforts should be directed towards improving vaccination levels among HIV-infected individuals.