Influenza vaccination is associated with lower risk of hospitalization outcomes among older adults with respiratory diseases, but there is limited evidence by disease subtypes and patients\' characteristics. This study included patients aged ≥60 years hospitalized for respiratory diseases from the Beijing Urban Employee Basic Medical Insurance database during 6 influenza seasons. Vaccination status was assessed by linking with the Beijing Elderly Influenza Vaccination database. Multi-variable logistic regression was performed to calculate effect estimates. After adjusting for measured and unmeasured confounders, influenza vaccination was associated with a lower risk of in-hospital death among older adults hospitalized for respiratory diseases (odds ratio [95% confidence interval], 0.70 [0.62-0.80]). The protective association was observed among patients with chronic obstructive pulmonary disease (0.67 [0.47-0.98]) as well as those with pneumonia or influenza (0.77 [0.64-0.93]). The protective association was stronger in younger patients (0.59 [0.43-0.81] for <75 and 0.72 [0.63-0.83] for ≥75) and those with fewer comorbidities (0.49 [0.16-1.62] for 0, 0.65 [0.50-0.86] for 1-2, and 0.72 [0.63-0.83] for ≥3 comorbidities). Influenza vaccination was associated with lower risk of in-hospital death among older patients hospitalized for respiratory diseases, with stronger associations in patients with younger age and fewer comorbidities.
We found that influenza vaccination was associated with lower risk of in-hospital death among older adults hospitalized for respiratory diseases. The associations were stronger in patients with younger age and fewer comorbidities. The study suggested that, in addition to prevent influenza itself, influenza vaccination may also prevent in-hospital death among patients with respiratory diseases.

OBJECTIVE: To estimate the coverage and willingness of pneumococcal vaccination and further explore the influencing factors of vaccination willingness among people in mainland China.
METHODS: Literature searches were conducted independently by two researchers in English- and Chinese-language databases from database inception to 6 October 2021. A random-effects meta-analysis model was used to derive summary vaccination coverage and willingness. Predefined subgroup analysis and meta-regression were performed to explore the sources of heterogeneity.
RESULTS: A total of 97 studies were included in this meta-analysis. The summary vaccination coverage in 76 included studies was 21.7% (95% confidence interval [CI]: 17.2%-26.5%). Subgroup analysis shows that the summary coverage was 29.0% (95% CI, 20.4%-39.1%) among the permanent residents and 20.7% (95% CI, 12.4%-35.9%) among the floating residents. The eastern and central regions presented higher coverage than the western region. Notable differences were observed between the various study populations. A total of 27 studies provided an estimation of vaccination willingness, with a summary willingness of 51.2% (95% CI, 40.4%-61.9%). In subgroup analysis, the summary willingness was 57.9% (95% CI, 48.3%-67.2%) in urban areas and 52.3% (95% CI, 40.8%-63.8%) in rural areas. Parents with children and people with a history of pneumonia were more willing to be vaccinated than the elderly. Recommendations by family members and physicians, previous pneumococcal and influenza vaccination, perceived vaccination effectiveness and severity of disease and a history of pneumonia contributed to vaccination willingness.
CONCLUSIONS: Compared to global estimates and other countries, pneumococcal vaccination coverage and willingness are at a lower level in mainland China. Recommendations for vaccination by family members and doctors, a history of vaccination and the perception of pneumonia and vaccination are associated with greater willingness to be vaccinated.

UNASSIGNED: 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is crucial to protecting high-risk groups. This study aimed to investigate the influencing factors of PPSV-23 recommendation among healthcare workers, and PPSV-23 coverage among Chinese older adults and chronic disease patients.
UNASSIGNED: In 2019, a cross-sectional questionnaire survey was conducted in ten provinces in China among older adults aged ≥65 years, chronic disease patients aged 18-64 years, and primary healthcare workers. Multiple logistic regression model was adopted to identify the influencing factors of PPSV-23 recommendation and vaccination uptake.
UNASSIGNED: Of the 1138 healthcare workers, 46.75% often recommended PPSV-23 to target groups, and public health workers were more likely to recommend than general practitioners. PPSV-23 vaccination rate was 3.29% among chronic disease patients aged <65 years, 6.69% among older adults without chronic disease(s), and 8.87% among chronic disease patients aged ≥65 years. Multiple logistic regression revealed that only general practitioners\' recommendation was associated with increased PPSV-23 coverage (p < 0.05).
UNASSIGNED: The findings highlighted the suboptimal PPSV-23 coverage rate in China and the strong association between healthcare workers\' recommendation and residents\' vaccination uptake. Targeted and coherent PPSV-23-related training is suggested for general practitioners to encourage effective health promotion in clinical practices.

Innoculation of pneumococcal vaccines among the elderly is an effective public health policy to prevent pneumococcal diseases and it is widely promoted by many developed countries. The pneumococcal vaccination rate among the elderly in China was only 3.7% in 2019, it grew rapidly during the early stage of the COVID-19 pandemic. The purpose of this cross-sectional study was to investigate the psychological and demographic-economic factors related to the uptake behavior of pneumococcal vaccination among the Chinese elderly by using an integrated model based on the unified theory of acceptance and use of technology (UTAUT), and knowledge, attitudes and practices (KAP). The theoretical model was tested via structural equation modeling (SEM) with data collected from 516 Chinese older adults aged 60 years and older. Our results suggested that knowledge, performance expectancy, effort expectancy, attitude, and trust had a significant correlation with behavioral intention; behavioral intention and trust had a positive correlation with the uptake behavior, gender, and and education level and chronic obstructive pulmonary disease exerted significant moderating effects. To increase the coverage of pneumococcal vaccination among the elderly, it is necessary to provide effective health education by authoritative experts, thereby enhancing their knowledge and positive attitude towardthe vaccination.

A lower conversion vaccination rate and a more rapid decline in antibody titers over time in dialysis patients raise concerns about the effectiveness of pneumococcal vaccination (PV) in this population, which has not been systematically reviewed.
We searched PubMed, Cochrane Library, Embase and three Chinese databases from inception until February 29th, 2020 for interventional, cohort and case-control studies evaluating PV alone or combined with influenza vaccination (IV) on outcomes (all-cause mortality, pneumonia, cardiovascular events, antibody response and safety). Independent reviewers completed citation screening, data extraction, risk assessment, meta-analysis, and GRADE rating of the quality of evidence.
Five cohort studies and one quasirandomized control trial enrolling 394,299 dialysis patients with high to moderate quality were included. Compared with unvaccinated individuals, those receiving PV had lower risk of all-cause mortality [Adjusted relative risk (RR) 0.73, 95% CI 0.67-0.79, I2 = 31.1%, GRADE low certainty] and cardiovascular events (adjusted RR 0.80, 95% CI 0.69-0.93, I2 = 47.2%, GRADE low certainty) without serious adverse effect reported. Compared with no vaccination, lower all-cause mortality was observed in those receiving PV combined with IV (Adjusted RR 0.71, 95%CI 0.67-0.75, I2 = 63.3%), PV alone (Adjusted RR 0.86, 95% CI 0.78-0.94,I2 = 0%], and IV alone (Adjusted RR 0.76, 95% CI 0.73-0.79, I2 = 0%]. There was no difference between pneumococcal vaccinated patients vs non-vaccinated patients with respect to pneumonia. Immune response to pneumococcal conjugate vaccine-13 was weaker in polysaccharide pneumococcal vaccine-23-pre-vaccinated compared with vaccine-naive patients.
The use of pneumococcal vaccine especially combined with influenza vaccination is associated with lower risks of all-cause mortality but may be affected by residual confounding/healthy vaccinee bias.

This study investigated the associations between illness representations of pneumonia and pneumococcal vaccination (PV) uptake among a group of community-living aging adults having at least one high-risk condition for severe invasive pneumococcal diseases (IPD). A total of 750 community-living Chinese-speaking individuals aged ≥65 y completed a random telephone survey. This study was based on 483 participants having at least one high-risk condition for severe IPD. The Illness Representation Questionnaire-Revised (IPQ-R) measured four dimensions of illness representations. These dimensions included timeline (whether pneumonia is believed to be acute/chronic), consequences (severity of pneumonia), treatment control (whether pneumonia is under volitional control), and emotional response (anger, guilty, or shame). Using PV uptake (among all participants) and behavioral intention to take up PV (among unvaccinated participants) as the dependent variables, logistic regression models were fitted. Among all participants (n = 483), 17.8% reported PV uptake; 18.6% of unvaccinated participants (n = 397) intended to take up two doses of free PV in the next year. After adjustment for significant background variables, participants who perceived more severe consequences of pneumonia (adjusted odds ratios, AOR: 1.18, 95%CI: 1.01, 1.40) and belief that treatment can control pneumonia (AOR: 1.41, 95%CI: 1.25, 1.58) reported higher PV uptake. Perceived pneumonia to be chronic (AOR: 1.44, 95%CI: 1.16, 1.78), belief that treatment can control pneumonia (AOR: 1.25, 95%CI: 1.12, 1.40) and having negative emotions related to pneumonia (AOR: 1.17, 95%CI: 1.09, 1.25) were positively associated with behavioral intention to take up PV. Results confirmed that illness representations were associated with PV-related behaviors.

Objective: To understand the pneumococcal vaccination rate in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention. Methods: COPD patients with post-bronchodilator FEV(1)/FVC<70% in COPD surveillance (2014-2015) of China were used as study subjects, in which 9 067 patients with definite pneumococcal vaccination status were included. The pneumococcal vaccination rate and its 95%CI in COPD patients were estimated using data adjusted by complicated sampling method. The factors in association with the vaccination rate were also identified. Results: The pneumococcal vaccination rate was 0.8% in the past five years in COPD patients aged 40 years or older in China (95%CI: 0.3%-1.4%). The vaccination rate was 0.3% in the patients aged 40 to 59 years (95%CI: 0.2%-0.5%) and 1.2% in the patients aged 60 years or older (95%CI: 0.3%-2.1%) (P<0.05). The rate was higher in the patients living in urban area (1.5%) than in those living in rural area (0.4%) (P<0.05). The vaccination rate increased with the severity of airflow limitation (P<0.05). The patients with comorbidities of other chronic lung diseases or diabetes had higher vaccination rate (1.7% and 2.1%) compared with those without comorbidities (P<0.05). The vaccination rate was 1.4% in former smokers and 0.6% in current smokers. The pneumococcal vaccination rate in COPD patients was associated with age, education level, occupation, the severity of airflow limitation and the history of influenza vaccination. Conclusions: The pneumococcal vaccination rate was extremely low in COPD patients aged 40 years or older in China. It is necessary to strengthen the health education and recommendation for pneumococcal vaccination in COPD patients through different measures.
目的： 了解我国≥40岁慢性阻塞性肺疾病（慢阻肺）患者的肺炎疫苗接种状况，为慢阻肺的防控提供科学依据。 方法： 将2014－2015年中国居民慢性阻塞性肺疾病监测中支气管舒张试验后测试FEV(1)/FVC<70%的调查对象作为慢阻肺患者，其中9 067名通过询问调查明确肺炎疫苗接种情况的患者被纳入本研究分析。应用复杂抽样调整方法，估计慢阻肺患者中的肺炎疫苗接种率及其95%CI，并对其影响因素进行分析。 结果： 我国≥40岁慢阻肺患者的5年内肺炎疫苗接种率是0.8%（95%CI：0.3%～1.4%）。40～岁组患者的肺炎疫苗接种率是0.3%（95%CI：0.2%～0.5%），≥60岁组患者的接种率为1.2%（95%CI：0.3%～2.1%）（P<0.05）；城镇患者的接种率（1.5%）高于乡村患者（0.4%）（P<0.05）；慢阻肺患者的气流受限程度越严重，其肺炎疫苗接种率越高（P<0.05）；合并其他慢性肺部疾病或糖尿病的患者接种率为1.7%、2.1%，高于未合并的患者（P<0.05）；曾经吸烟的慢阻肺患者肺炎疫苗接种率为1.4%，现在吸烟的患者接种率为0.6%。慢阻肺患者的肺炎疫苗接种与年龄、文化程度、职业、气流受限严重程度分级、流感疫苗接种史有关。 结论： 我国≥40岁慢阻肺患者的肺炎疫苗接种率非常低，需要采取多种措施加强对慢阻肺患者的健康教育与肺炎疫苗接种推荐。.

Individuals aged ≥65 y are recommended to receive pneumococcal vaccination (PV). PV completion is defined as receiving two doses of PV among those with at least one high-risk condition for severe invasive pneumococcal diseases (IPD) or receiving one dose of PV among those without any high-risk conditions. This study investigated factors associated with PV completion among a random sample of community-living older adults in Hong Kong, China. In addition, factors associated with receiving a single dose of PV among older adults with at least one high-risk condition were also investigated. A total of 750 community-living Chinese-speaking individuals aged ≥65 y in Hong Kong (response rate: 63.4%) completed a random telephone survey from May to July 2019. PV completion was 10% among all participants. Among participants with high-risk condition(s) for severe IPD, 11.4% received a single dose of PV. After adjustment for significant background variables, several Health Belief Model constructs were significantly associated with both dependent variables: (1) perceived risk of contracting pneumococcal diseases, (2) perceived benefits of PV for protecting themselves or others, (3) perceived barriers to PV uptake, (4) being suggested by significant others to take up PV (cue to action), and (5) confidence to take up PV (perceived self-efficacy). In addition, being knowledgeable about pneumococcal diseases and vaccination, and knowing at least one peer of similar age who had taken up PV were also positively associated with both dependent variables. Targeted, theory-based health promotion efforts are needed to increase PV coverage among elderly in Hong Kong.

The advantages of dual pneumococcal and influenza vaccination in older adults have not been clarified and controversy remains regarding their optimal use.
This meta-analysis was conducted on 25 January 2018 using PubMed, the Cochrane Library, and Embase databases. Seventeen studies were selected ultimately for meta-analysis using a multi-step approach by two separate authors. Primary outcomes were pneumonia, pneumococcal pneumonia, influenza, hospitalization, and all-cause mortality rates, and the secondary outcome was adverse effects (AEs).
The additive preventive effects of dual influenza and pneumococcal vaccination versus influenza vaccination alone for pneumonia and death were 15% (95% confidence interval [CI]: 4-24%) and 19% (95% CI: 6-30%), respectively. Compared with pneumococcal vaccination alone, dual influenza and pneumococcal vaccination resulted in a 24% (95% CI: 16-31%) reduction in pneumonia and a 28% (95% CI: 13-40%) reduction in death. Compared with placebo or no vaccination, the effectiveness of dual vaccination was 29% (95% CI: 14-42%) for pneumonia, 38% (95% CI: 25-49%) for death, 35% (95% CI: 22-46%) for influenza, and 18% (95% CI: 6-29%) for hospitalization. Both vaccines showed acceptable safety profiles and AEs were mild or moderate.
Our findings highlight the importance of concomitant influenza and pneumococcal vaccination in older adults.

OBJECTIVE: To investigate the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-PPV) in the Chinese urban elderly population and to understand the attitudes, knowledge and beliefs of this population toward the 23-PPV vaccination.
METHODS: A cross-sectional approach was employed to survey the willingness of this population to receive the 23-PPV vaccination. Two thousand 9 hundred 2 six subjects over the age of 60 y were enrolled via a multi-stage random sampling method from the urban community population in Hangzhou, China. The relationships between the variables and the willingness to receive the 23-PPV vaccination were computed as odds ratios (ORs) by multivariate analysis.
RESULTS: Of the participants, 21.77% were willing to undergo 23-PPV vaccination, and 61.65% of the subjects agreed that pneumonia is a serious disease among elderly people. The rate of reasonable perceptions about vaccination, including the perception about vaccine efficacy and safety, among the subjects was below 50%. Only 1.23% of subjects had been vaccinated with 23-PPV, and a similarly low rate was observed for the seasonal influenza vaccine (4.17%). The factors that were independently related to the willingness to receive the 23-PPV vaccine included consensus with the hazards of pneumonia (OR = 1.67, 95% CI: 1.28 - 2.17), the safety of vaccination (OR = 2.00, 95% CI: 1.54 - 2.59), advice about the 23-PPV vaccination from family members (OR = 2.37, 95% CI: 1.39 - 4.40), influenza vaccination history (OR = 2.57, 95% CI: 1.66 - 3.98) and pneumococcal vaccination history (OR = 7.48, 95% CI: 2.4-22.92).
CONCLUSIONS: The administration of the 23-PPV vaccine among the urban elderly population is not optimistic in China. Emphasis on persuasion from families and the improvement of knowledge about vaccination might encourage elderly people to get the 23-PPV vaccination. Suggestions from physicians did not affect the participants\' willingness to get the 23-PPV vaccination in multivariate analysis, but elderly people typically visited the Community Health Center (CHC) in their residential districts, and thus, systematic encouragement from healthcare physicians might be the key to increasing 23-PPV vaccination.