{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:26:44Z","timestamp":1790407604874,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2016,10,28]],"date-time":"2016-10-28T00:00:00Z","timestamp":1477612800000},"content-version":"vor","delay-in-days":1031,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background. \u2003Although it is widely accepted that adults with immunocompromising conditions are at greatly increased risk of pneumococcal infection, the extent of risk among immunocompetent adults with chronic medical conditions is less certain, particularly in the current era of universal vaccination of children with pneumococcal conjugate vaccines.<\/jats:p>\n                  <jats:p>Methods. \u2003We conducted a retrospective cohort study using data from 3 healthcare claims repositories (2006\u20132010) to compare rates of pneumococcal disease in immunocompetent adults with chronic medical conditions (\u201cat-risk\u201d) and immunocompromised adults (\u201chigh-risk\u201d), with rates in adults without these conditions (\u201chealthy\u201d). Risk profiles and episodes of pneumococcal disease\u2014all-cause pneumonia, pneumococcal pneumonia, and invasive pneumococcal disease (IPD)\u2014were ascertained from diagnosis, procedure, and drug codes.<\/jats:p>\n                  <jats:p>Results. \u2003Rates of all-cause pneumonia among at-risk persons aged 18\u201349 years, 50\u201364 years, and \u226565 years were 3.2 (95% confidence interval [CI], 3.1\u20133.2), 3.1 (95% CI, 3.1\u20133.1), and 3.0 (95% CI, 3.0\u20133.0) times the rates in age-matched healthy counterparts, respectively. We idetified rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, and neuromuscular or seizure disorders as additional at-risk conditions for pneumococcal disease. Among persons with at-risk conditions, the rate of all-cause pneumonia substantially increased with the accumulation of concurrent at-risk conditions (risk stacking): among persons 18\u201349 years, rate ratios increased from 2.5 (95% CI, 2.5\u20132.5) in those with 1 at-risk condition to 6.2 (95% CI, 6.1\u20136.3) in those with 2 conditions, and to 15.6 (95% CI, 15.3\u201316.0) in those with \u22653 conditions. Findings for pneumococcal pneumonia and IPD were similar.<\/jats:p>\n                  <jats:p>Conclusions. \u2003Despite widespread use of pneumococcal conjugate vaccines, rates of pneumonia and IPD remain disproportionately high in adults with at-risk conditions, including those with conditions not currently included in the Advisory Committee on Immunization Practices\u2019 guidelines for prevention and those with multiple at-risk conditions.<\/jats:p>","DOI":"10.1093\/ofid\/ofu024","type":"journal-article","created":{"date-parts":[[2014,5,9]],"date-time":"2014-05-09T23:05:35Z","timestamp":1399676735000},"source":"Crossref","is-referenced-by-count":239,"title":["Rates of Pneumococcal Disease in Adults With Chronic Medical Conditions"],"prefix":"10.1093","volume":"1","author":[{"given":"Kimberly M.","family":"Shea","sequence":"first","affiliation":[{"name":"Boston University Schools of Medicine and Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Edelsberg","sequence":"additional","affiliation":[{"name":"Policy Analysis Inc. (PAI), Brookline, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Weycker","sequence":"additional","affiliation":[{"name":"Policy Analysis Inc. (PAI), Brookline, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond A.","family":"Farkouh","sequence":"additional","affiliation":[{"name":"Pfizer Inc., Collegeville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Strutton","sequence":"additional","affiliation":[{"name":"Pfizer Inc., Collegeville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen I.","family":"Pelton","sequence":"additional","affiliation":[{"name":"Boston University Schools of Medicine and Public Health, Boston, Massachusetts"},{"name":"Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,5,27]]},"reference":[{"key":"2020081009363491600_OFU024C1","first-page":"273","article-title":"Update: pneumococcal polysaccharide vaccine usage\u2014United States","volume":"33","author":"Centers for Disease Control and Prevention (CDC)","year":"1984","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020081009363491600_OFU024C2","first-page":"1","article-title":"Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices","volume":"46","author":"Centers for Disease Control and Prevention (CDC)","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020081009363491600_OFU024C3","first-page":"1102","article-title":"Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23)","volume":"59","author":"Centers for Disease Control and Prevention (CDC)","year":"2010","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020081009363491600_OFU024C4","first-page":"816","article-title":"Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020081009363491600_OFU024C5","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1056\/NEJMoa1209165","article-title":"US hospitalizations for pneumonia after a decade of pneumococcal vaccination","volume":"369","author":"Griffin","year":"2013","journal-title":"N Engl J Med"},{"key":"2020081009363491600_OFU024C6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1086\/648593","article-title":"Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine","volume":"201","author":"Pillishvilli","year":"2010","journal-title":"J Infect Dis"},{"key":"2020081009363491600_OFU024C7","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1136\/jech-2011-200168","article-title":"Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses","volume":"66","author":"Wotton","year":"2012","journal-title":"J Epidemiol Community Health"},{"key":"2020081009363491600_OFU024C8","doi-asserted-by":"crossref","first-page":"e329","DOI":"10.3399\/bjgp09X472629","article-title":"Idetification of new risk factors for pneumonia: population-based case-control study","volume":"59","author":"Vinogradova","year":"2009","journal-title":"Br J Gen Pract"},{"key":"2020081009363491600_OFU024C9","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1056\/NEJMoa051721","article-title":"Influenza-associated deaths among children in the United States, 2003\u20132004","volume":"353","author":"Bhat","year":"2005","journal-title":"N Engl J Med"},{"key":"2020081009363491600_OFU024C10","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jinf.2012.02.017","article-title":"The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England","volume":"65","author":"van Hoek","year":"2012","journal-title":"J Infect"},{"key":"2020081009363491600_OFU024C11","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1093\/cid\/cis971","article-title":"Epidemiology of invasive pneumococcal disease among high-risk adults since the introduction of pneumococcal conjugate vaccine for children","volume":"56","author":"Muhammad","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2020081009363491600_OFU024C12","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1056\/NEJM199503233321202","article-title":"Risk factors for hip fracture in white women. 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