Spain is facing challenges in protecting its aging population from pneumococcal disease, despite high vaccination rates among children. While pneumococcal infections-which can manifest as pneumonia, meningitis, and bloodstream infections-have been dramatically reduced in young children through routine vaccination, adult coverage lags far behind national targets, raising concerns about preventable hospitalizations and deaths [[1]]. New data reveals a notable gap between Spain’s 75% vaccination goal for adults over 65 and the current rate of just 41.15%, prompting calls for renewed public health efforts.
Spain is falling short of its vaccination goals for pneumococcal disease in adults, raising concerns about increased hospitalizations and deaths from the potentially serious bacterial infection. While the country has achieved high vaccination rates in children, coverage among older adults remains significantly lower, according to recent data.
The Spanish Ministry of Health aimed to reach a 75% pneumococcal vaccination rate for adults over 65 by 2025, a target mirroring ambitions for influenza vaccination. However, current figures reveal a substantial gap. As of the latest statistics from the Ministry of Health portal, only 41.15% of individuals aged 66 and older have received the recommended dose, and just 56.11% of those over 74 are up-to-date.
“The problem with adults is that we vaccinate only 40%, and at that level, we don’t see a reduction in cases,” explained Ángel Gil, a professor of Preventive Medicine and Public Health at the Rey Juan Carlos University of Madrid. He noted that vaccination rates in adults have historically remained low, “never exceeding 30-40%.”
While current vaccines don’t protect against all 107 known serotypes of pneumococcus, they have been improved to target the strains responsible for the most frequent and severe infections, covering 20 serotypes, Gil clarified.
Pneumococcal disease remains a leading cause of illness and death worldwide. In Spain alone, it was the eighth leading cause of death in 2023, contributing to 10,340 fatalities. This underscores the importance of preventative measures like vaccination.
Increasing vaccination coverage to 75% in older adults could dramatically reduce hospital admissions, potentially by as much as 88%, according to Gil. This would have a significant impact on the healthcare system and improve patient outcomes.
Pneumonia, a common manifestation of pneumococcal disease, is often well-managed by family doctors in older adults, with 75% of patients recovering without hospitalization. However, 25% require hospital care, and the mortality rate among those 65 and older admitted with pneumococcal pneumonia is 15%. The risk of death is even higher for individuals with underlying health conditions.
Hospitalization for pneumonia can also significantly diminish quality of life, potentially leading to intensive care unit stays and exacerbation of chronic illnesses. For example, an older adult with type 2 diabetes hospitalized for pneumonia may experience destabilization of their blood sugar control, requiring adjustments to medication and potentially lifelong insulin therapy, Gil explained.
A retrospective study published on Monday, January 29, 2024, in Human Vaccine & Immunotherapeutics identified 66,391 patients hospitalized with pneumococcal disease in 2023. The annual hospitalization rate was 140.94 cases per 100,000 people, increasing significantly with age to 1,046.53 hospitalizations per 100,000 among those 90 and older. Men were hospitalized with pneumococcal disease at higher rates than women across all age groups.
The study also found a mortality rate of 13.27 deaths per 100,000 inhabitants due to pneumococcal diseases. Mortality peaked in individuals aged 90 or older, reaching 20.74 per 100,000. Among the three pneumococcal conditions analyzed, sepsis had the highest hospital mortality rate (22.83 deaths per 100,000), followed by pneumonia (8.37) and meningitis (7.20). Men consistently exhibited higher mortality rates than women.
Patients with at least one comorbidity experienced a significantly higher mortality rate (14.87%) compared to those without underlying conditions (2.58%). These findings highlight the critical role of vaccination, particularly for individuals with pre-existing health issues.
The pneumococcal vaccine can be administered at any time of year, as the bacteria is not seasonal, and currently, a single dose provides lifelong protection for adults. However, Gil suggests that booster doses may be needed. “Today, we say the vaccine against pneumonia is a lifetime dose, and I don’t agree, because the protection of the vaccine will possibly be for 10 years. When our life expectancy was shorter, that was fine, but today, a booster dose is needed at 80-85 years old.”
€383 Million Annual Cost
Economic data further supports the importance of utilizing conjugated vaccines with broad serotype coverage and strengthening vaccination policies. The annual cost of hospitalizations for pneumonia exceeded €383 million, according to a retrospective study of 2016 and 2022 published in January 2024 in the same journal.
High Vaccination Rates in Children
►Vaccination schedules for children in Spain include doses at 2, 4, 6, and 11 months of age. Awareness and uptake of the vaccine are high in this population, exceeding the target of 95% with a 98% vaccination rate. This has led to a nearly 99% reduction in hospital admissions for pneumococcal disease in children, Gil stated.
The mortality rate among children hospitalized with pneumococcal disease is 5%, with the highest risk among premature infants, those with a history of bronchiolitis, asthma, or hyaline membrane disease.
