{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:52:01Z","timestamp":1784191921368,"version":"3.55.0"},"reference-count":182,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette\u2013Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.<\/jats:p>","DOI":"10.3390\/vaccines9050474","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T02:54:58Z","timestamp":1620615298000},"page":"474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3298-9306","authenticated-orcid":false,"given":"Robert","family":"Root-Bernstein","sequence":"first","affiliation":[{"name":"Department of Physiology, 567 Wilson Road, Room 1104 Biomedical and Physical Sciences Building, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S1473-3099(20)30833-1","article-title":"SARS-CoV-2 seroprevalence and transmission risk factors among high-risk close contacts: A retrospective cohort study","volume":"21","author":"Ng","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1503\/cmaj.202065","article-title":"Symptoms associated with a positive result for a swab for SARS-CoV-2 infection among children in Alberta","volume":"193","author":"King","year":"2021","journal-title":"Can. Med Assoc. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"eabe3024","DOI":"10.1126\/sciadv.abe3024","article-title":"Distinct inflammatory profiles distinguish COVID-19 from influenza with limited contributions from cytokine storm","volume":"6","author":"Mudd","year":"2020","journal-title":"Sci. Adv."},{"key":"ref_4","unstructured":"Worldometer (2021, April 30). COVID-19. Available online: https:\/\/www.worldometers.info\/coronavirus\/coronavirus-cases\/#daily-cases."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Root-Bernstein, R. (2020). Age and Location in Severity of COVID-19 Pathology: Do Lactoferrin and Pneumococcal Vaccination Explain Low Infant Mortality and Regional Differences?. BioEssays, 42.","DOI":"10.1002\/bies.202000076"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Root-Bernstein, R. (2020). Possible Cross-Reactivity between SARS-CoV-2 Proteins, CRM197 and Proteins in Pneumococcal Vaccines May Protect Against Symptomatic SARS-CoV-2 Disease and Death. Vaccines, 8.","DOI":"10.20944\/preprints202007.0141.v3"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"342","DOI":"10.3389\/fmicb.2016.00342","article-title":"The Association between Invasive Group A Streptococcal Diseases and Viral Respiratory Tract Infections","volume":"7","author":"Herrera","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_8","first-page":"1","article-title":"Antigenic complementarity between influenza a virus and Haemophilus influenzae may drive lethal co-infection such as that seen in 1918-19","volume":"2","author":"Podufaly","year":"2013","journal-title":"J. Virol. Antivir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1086\/591708","article-title":"Predominant role of bacterial pneumonia as a cause of death in pan-demic influenza: Implications for pandemic influenza preparedness","volume":"198","author":"Morens","year":"2008","journal-title":"J. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S1473-3099(06)70466-2","article-title":"Interactions between influenza and bacterial respiratory pathogens: Implications for pandemic preparedness","volume":"6","author":"Brundage","year":"2006","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.3201\/eid1408.071313","article-title":"Deaths from bacterial pneumonia in the 1918\u20131919 influenza pandemic","volume":"14","author":"Brundage","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00253-020-10814-6","article-title":"The microbial coinfection in COVID-19","volume":"104","author":"Chen","year":"2020","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Miellet, W.R., Van Veldhuizen, J., Nicolaie, A.M., Mariman, R., Bootsma, H.J., Bosch, T., Rots, N.Y., Sanders, E.A.M., Van Beek, J., and Trzci\u0144ski, K. (2020). Influenza-like Illness Exacerbates Pneumococcal Carriage in Older Adults. Clin. Infect. Dis., 30.","DOI":"10.1093\/cid\/ciaa1551"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/j.ajic.2020.06.185","article-title":"Bacterial and fungal colonization of the respiratory tract in COVID-19 patients should not be neglected","volume":"48","author":"Intra","year":"2020","journal-title":"Am. J. Infect. Control."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/irv.12398","article-title":"The frequency of influenza and bacterial coinfection: A systematic review and meta-analysis","volume":"10","author":"Klein","year":"2016","journal-title":"Influ. Respir. Viruses"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jmii.2020.05.013","article-title":"Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?","volume":"53","author":"Lai","year":"2020","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.micinf.2020.05.007","article-title":"Clinical characteristics and co-infections of 354 hospitalized patients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"22","author":"Lv","year":"2020","journal-title":"Microbes Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.medcli.2020.05.022","article-title":"Pneumococcal superinfection in COVID-19 patients: A series of 5 cases","volume":"155","author":"Cucchiari","year":"2020","journal-title":"Med. Cl\u00ednica"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.cmi.2020.07.041","article-title":"Incidence of co-infections and superinfections in hospitalized patients with COVID-19: A retrospective cohort study","volume":"27","author":"Sanjuan","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13613-020-00736-x","article-title":"Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU","volume":"10","author":"Contou","year":"2020","journal-title":"Ann. Intensiv. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"198005","DOI":"10.1016\/j.virusres.2020.198005","article-title":"Co-infection with respiratory pathogens among COVID-2019 cases","volume":"285","author":"Zhu","year":"2020","journal-title":"Virus Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1016\/j.jinf.2020.12.004","article-title":"Total infectomes of 162 SARS-CoV-2 cases using meta-transcriptomic sequencing","volume":"82","author":"Zhou","year":"2021","journal-title":"J. Infect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.jinf.2020.03.019","article-title":"Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up","volume":"80","author":"Wang","year":"2020","journal-title":"J. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104364","DOI":"10.1016\/j.jcv.2020.104364","article-title":"Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China","volume":"127","author":"Zhang","year":"2020","journal-title":"J. Clin. Virol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1164\/rccm.202002-0445OC","article-title":"COVID-19 with Different Severities: A Multicenter Study of Clinical Features","volume":"201","author":"Feng","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Townsend, L., Hughes, G., Kerr, C., Kelly, M., O\u2019Connor, R., Sweeney, E., Doyle, C., O\u2019Riordan, R., Martin-Loeches, I., and Bergin, C. (2020). Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection. JAC Antimicrob. Resist., 2.","DOI":"10.1093\/jacamr\/dlaa071"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s10096-020-04063-8","article-title":"Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: A retrospective cohort study in light of antibiotic stewardship","volume":"40","author":"Rothe","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/j.cmi.2020.06.025","article-title":"Bacterial and fungal coinfection among hospitalized patients with COVID-19: A retrospective cohort study in a UK secondary-care setting","volume":"26","author":"Hughes","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.2147\/IDR.S267238","article-title":"Coinfection of SARS-CoV-2 and Other Respiratory Pathogens","volume":"13","author":"Ma","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Vaillancourt, M., and Jorth, P. (2020). The Unrecognized Threat of Secondary Bacterial Infections with COVID-19. mBio, 11.","DOI":"10.1128\/mBio.01806-20"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rawson, T.M., Moore, L.S.P., Zhu, N., Ranganathan, N., Skolimowska, K., Gilchrist, M., Satta, G., Cooke, G., and Holmes, A. (2020). Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin. Infect. Dis.","DOI":"10.1093\/cid\/ciaa530"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jinf.2020.05.046","article-title":"Co-infections in people with COVID-19: A systematic review and meta-analysis","volume":"81","author":"Lansbury","year":"2020","journal-title":"J. Infect."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Bengoechea, J.A., and Bamford, C.G. (2020). SARS-CoV-2, bacterial co-infections, and AMR: The deadly trio in COVID-19?. EMBO Mol. Med., 12.","DOI":"10.15252\/emmm.202012560"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.cmi.2020.04.024","article-title":"COVID-19: Don\u2019t neglect antimicrobial stewardship principles!","volume":"26","author":"Huttner","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1002\/jmv.26125","article-title":"Influenza and COVID-19 coinfection: Report of six cases and review of the literature","volume":"92","author":"Ozaras","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1002\/jmv.25781","article-title":"The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China","volume":"92","author":"Ding","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hashemi, S.A., Safamanesh, S., Ghafouri, M., Taghavi, M.R., Heydari, M.S.M.Z., Abad, H.N.A., Zadeh-Moghaddam, H.G., and Azimian, A. (2020). Co-infection with COVID-19 and influenza A virus in two died patients with acute respiratory syndrome, Bojnurd, Iran. J. Med. Virol., 92.","DOI":"10.1002\/jmv.26014"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.ijid.2020.05.068","article-title":"Clinical characteristics of critically ill patients co-infected with SARS-CoV-2 and the influenza virus in Wuhan. China","volume":"96","author":"Ma","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1016\/S0140-6736(20)31052-7","article-title":"SARS-CoV-2 and influenza virus co-infection","volume":"395","author":"Bodro","year":"2020","journal-title":"Lancet"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"5398","DOI":"10.1016\/j.vaccine.2020.06.047","article-title":"Use of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality","volume":"38","author":"Thindwa","year":"2020","journal-title":"Vaccine"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Nunes, M.C., Cutland, C.L., Klugman, K.P., and Madhi, S.A. (2021). Pneumococcal Conjugate Vaccine Protection against Coronavirus-Associated Pneumonia Hospitalization in Children Living with and without HIV. mBio, 12.","DOI":"10.1128\/mBio.02347-20"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1016\/j.chest.2020.05.580","article-title":"Individualizing Risk Prediction for Positive Coronavirus Disease 2019 Testing","volume":"158","author":"Jehi","year":"2020","journal-title":"Chest"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-021-83641-y","article-title":"Exploratory analysis of immunization records highlights decreased SARS-CoV-2 rates in individuals with recent non-COVID-19 vaccinations","volume":"11","author":"Pawlowski","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Noale, M., Trevisan, C., Maggi, S., Incalzi, R.A., Pedone, C., Di Bari, M., Adorni, F., Jesuthasan, N., Sojic, A., and Galli, M. (2020). The Association between Influenza and Pneumococcal Vaccinations and SARS-Cov-2 Infection: Data from the EPICOVID19 Web-Based Survey. Vaccines, 8.","DOI":"10.3390\/vaccines8030471"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Lewnard, A.J., Bruxvoort, K.J., Fischer, H., Hong, V.X., Grant, L.R., J\u00f3dar, L., Gessner, B.D., and Tartof, S.Y. (2021). Prevention of COVID-19 among older adults receiving pneumococcal conjugate vaccine suggests interactions between Streptococcus pneumoniae and SARS-CoV-2 in the respiratory tract. J. Infect. Dis., 128.","DOI":"10.1093\/infdis\/jiab128"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e10910","DOI":"10.7717\/peerj.10910","article-title":"Is there a link between pre-existing antibodies acquired due to childhood vaccinations or past infections and COVID-19? A case control study","volume":"9","author":"Sumbul","year":"2021","journal-title":"PeerJ"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Fink, G., Orlova-Fink, N., Schindler, T., Grisi, S., Ferrer, A.P.S., Daubenberger, C., and Brentani, A. (2020). Inactivated trivalent influenza vaccination is associated with lower mortality among patients with COVID-19 in Brazil. BMJ Evid. Based Med.","DOI":"10.1101\/2020.06.29.20142505"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Amato, M., Werba, J.P., Frigerio, B., Coggi, D., Sansaro, D., Ravani, A., Ferrante, P., Veglia, F., Tremoli, E., and Baldassarre, D. (2020). Relationship between Influenza Vaccination Coverage Rate and COVID-19 Outbreak: An Italian Ecological Study. Vaccines, 8.","DOI":"10.3390\/vaccines8030535"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"106351","DOI":"10.1016\/j.ypmed.2020.106351","article-title":"Vaccination against seasonal influenza and socio-economic and environmental factors as determinants of the geographic variation of COVID-19 incidence and mortality in the Italian elderly","volume":"143","author":"Cocco","year":"2021","journal-title":"Prev. Med."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Arokiaraj, M.C. (2020). Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality\u2014Perspectives. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00444"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Zanettini, C., Omar, M., Dinalankara, W., Imada, E.L., Colantuoni, E., Parmigiani, G., and Marchionni, L. (2020). Influenza vac-cination and COVID19 mortality in the USA. medRxiv.","DOI":"10.1101\/2020.06.24.20129817"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Del Riccio, M., Lorini, C., Bonaccorsi, G., Paget, J., and Caini, S. (2020). The Association between Influenza Vaccination and the Risk of SARS-CoV-2 Infection, Severe Illness, and Death: A Systematic Review of the Literature. Int. J. Environ. Res. Public Health, 17.","DOI":"10.20944\/preprints202009.0702.v1"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1002\/jmv.26120","article-title":"Epidemiological evidence for association between higher influenza vaccine uptake in the elderly and lower COVID-19 deaths in Italy","volume":"93","author":"Schwartz","year":"2021","journal-title":"J. Med Virol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Gold, J.E., Baumgartl, W.H., Okyay, R.A., Licht, W.E., Fidel, P.L., Noverr, M.C., Tilley, L.P., Hurley, D.J., Rada, B., and Ashford, J.W. (2020). Analysis of Measles-Mumps-Rubella (MMR) Titers of Recovered COVID-19 Patients. mBio, 11.","DOI":"10.1128\/mBio.02628-20"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.amjmed.2020.10.003","article-title":"MMR Vaccination: A Potential Strategy to Reduce Severity and Mortality of COVID-19 Illness","volume":"134","author":"Ashford","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Fidel, P.L., and Noverr, M.C. (2020). Could an Unrelated Live Attenuated Vaccine Serve as a Preventive Measure To Dampen Septic Inflammation Associated with COVID-19 Infection?. mBio, 11.","DOI":"10.1128\/mBio.00907-20"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0950268821000571","article-title":"Association between live childhood vaccines and COVID-19 outcomes: A national-level analysis","volume":"149","author":"Ogimi","year":"2021","journal-title":"Epidemiol. Infect."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Klinger, D., Blass, I., Rappoport, N., and Linial, M. (2020). Significantly Improved COVID-19 Outcomes in Countries with Higher BCG Vaccination Coverage: A Multivariable Analysis. Vaccines, 8.","DOI":"10.1101\/2020.04.23.20077123"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Baz, I., Trobajo-Sanmart\u00edn, C., Arregui, I., Navascu\u00e9s, A., Adelantado, M., Indurain, J., Fres\u00e1n, U., Ezpeleta, C., and Castilla, J. (2020). Influenza Vaccination and Risk of SARS-CoV-2 Infection in a Cohort of Health Workers. Vaccines, 8.","DOI":"10.3390\/vaccines8040611"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/occmed\/kqaa197","article-title":"Association between seasonal flu vaccination and COVID-19 among healthcare workers","volume":"70","author":"Belingheri","year":"2020","journal-title":"Occup. Med."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Ragni, P., Marino, M., Formisano, D., Bisaccia, E., Scaltriti, S., Bedeschi, E., and Grilli, R. (2020). Association between Exposure to Influenza Vaccination and COVID-19 Diagnosis and Outcomes. Vaccines, 8.","DOI":"10.3390\/vaccines8040675"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1007\/s10875-020-00925-0","article-title":"A Case\u2013Control Study of the 2019 Influenza Vaccine and Incidence of COVID-19 Among Healthcare Workers","volume":"41","author":"Massoudi","year":"2021","journal-title":"J. Clin. Immunol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Gopalaswamy, R., Ganesan, N., Velmurugan, K., Aravindhan, V., and Subbian, S. (2020). The Strange Case of BCG and COVID-19: The Verdict Is Still up in the Air. Vaccines, 8.","DOI":"10.3390\/vaccines8040612"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2174\/1874306402014010045","article-title":"BCG Vaccine does not Protect Against COVID-19","volume":"14","author":"Allam","year":"2020","journal-title":"Open Respir. Med. J."},{"key":"ref_67","first-page":"207","article-title":"Stop playing with data: There is no sound evidence that Bacille Calmette-Gu\u00e9rin may avoid SARS-CoV-2 infection (for now)","volume":"91","author":"Gualerzi","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Chimoyi, L., Velen, K., Churchyard, G.J., Wallis, R., Lewis, J.J., and Charalambous, S. (2020). An ecological study to evaluate the association of Bacillus Calmette-Guerin (BCG) vaccination on cases of SARS-CoV2 infection and mortality from COVID-19. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243707"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1001\/jama.2020.8189","article-title":"SARS-CoV-2 Rates in BCG-Vaccinated and Unvaccinated Young Adults","volume":"323","author":"Hamiel","year":"2020","journal-title":"JAMA"},{"key":"ref_70","first-page":"87","article-title":"The Spread of COVID-19 and the BCG Vaccine: A Natural Experiment in Reunified Germany","volume":"19","author":"Bluhm","year":"2020","journal-title":"SSRN Electron. J."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"De Chaisemartin, C., and De Chaisemartin, L. (2020). Bacille Calmette-Gu\u00e9rin Vaccination in Infancy Does Not Protect Against Coronavirus Disease 2019 (COVID-19): Evidence from a Natural Experiment in Sweden. Clin. Infect. Dis.","DOI":"10.1101\/2020.06.22.20137802"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Rivas, M.N., Ebinger, J.E., Wu, M., Sun, N., Braun, J., Sobhani, K., Van Eyk, J.E., Cheng, S., and Arditi, M. (2021). BCG vaccination history associates with decreased SARS-CoV-2 seroprevalence across a diverse cohort of health care workers. J. Clin. Investig., 131.","DOI":"10.1172\/JCI145157"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"100073","DOI":"10.1016\/j.xcrm.2020.100073","article-title":"Safety and COVID-19 Symptoms in Individuals Recently Vaccinated with BCG: A Retrospective Cohort Study","volume":"1","author":"Moorlag","year":"2020","journal-title":"Cell Rep. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.jgar.2020.07.005","article-title":"Could Bordetella pertussis vaccine protect against coronavirus COVID-19?","volume":"22","author":"Alkholy","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"109779","DOI":"10.1016\/j.mehy.2020.109779","article-title":"SARS\u2014CoV-2: Reasons of epidemiology of severe ill disease cases and therapeutic approach using trivalent vaccine (tetanus, diphtheria and Bordetella pertussis)","volume":"141","author":"Ietto","year":"2020","journal-title":"Med. Hypotheses"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"110305","DOI":"10.1016\/j.mehy.2020.110305","article-title":"COVID-19 in children: Could pertussis vaccine play the protective role?","volume":"145","author":"Ismail","year":"2020","journal-title":"Med. Hypotheses"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"586984","DOI":"10.3389\/fimmu.2020.586984","article-title":"Potential Cross-Reactive Immunity to SARS-CoV-2 From Common Human Pathogens and Vaccines","volume":"11","author":"Reche","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.cell.2020.04.042","article-title":"Trained Immunity: A Tool for Reducing Susceptibility to and the Severity of SARS-CoV-2 Infection","volume":"181","author":"Netea","year":"2020","journal-title":"Cell"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"115199","DOI":"10.1016\/j.diagmicrobio.2020.115199","article-title":"Respiratory bacterial pathogen spectrum among COVID-19 infected and non\u2013COVID-19 virus infected pneumonia patients","volume":"98","author":"He","year":"2020","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_80","first-page":"92","article-title":"Is Bordetella pertussis co-infecting SARS-CoV-2 patients?","volume":"71","author":"Renzi","year":"2021","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S1473-3099(18)30310-4","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"Troeger","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.rmed.2018.02.007","article-title":"Burden of pneumococcal community-acquired pneumonia in adults across Europe: A literature review","volume":"137","author":"Torres","year":"2018","journal-title":"Respir. Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/j.ijid.2009.05.010","article-title":"Burden of invasive pneumococcal disease and serotype distribution among Streptococcus pneumoniae isolates in young children in Europe: Impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines","volume":"14","author":"Isaacman","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"ref_84","unstructured":"European Centre for Disease Prevention and Control (2021, February 08). Invasive Pneumococcal Disease Surveillance and Disease Data Disease Data from ECDC Surveillance Atlas. Available online: https:\/\/www.ecdc.europa.eu\/en\/pneumococcal-disease\/surveillance-and-disease-data\/atlas."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1136\/thoraxjnl-2018-211767","article-title":"Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: Implications for adult vaccination","volume":"74","author":"Hanquet","year":"2018","journal-title":"Thorax"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1080\/21645515.2016.1159363","article-title":"Surveillance of pneumococcal diseases in Central and Eastern Europe","volume":"12","author":"Ceyhan","year":"2016","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.tmaid.2018.05.016","article-title":"Incidence of invasive pneumococcal disease in immunocompromised patients: A systematic review and meta-analysis","volume":"24","author":"Spijker","year":"2018","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Quattrone, F., Donzelli, G., D\u2019Arienzo, S., Fornili, M., Innocenti, F., Forni, S., Baglietto, L., Tavoschi, L., and Lopalco, P.L. (2020). Invasive Pneumococcal Disease in Tuscany Region, Italy, 2016\u20132017: Integrating Multiple Data Sources to Investigate Underreporting. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17207581"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0950268820001077","article-title":"Impact of vaccination on invasive pneumococcal disease in Italy 2007\u20132017: Surveillance challenges and epidemiological changes","volume":"148","author":"Monali","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4236\/wjv.2012.23018","article-title":"Characteristics of Invasive Pneumococcal Disease in Young Children before the Introduction of PCV13 in Lombardy, Italy","volume":"2","author":"Radaelli","year":"2012","journal-title":"World J. Vaccines"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1016\/j.vaccine.2013.02.059","article-title":"A nationwide surveillance of invasive pneumococcal disease in adults in Israel before an expected effect of PCV7","volume":"31","author":"Rahav","year":"2013","journal-title":"Vaccine"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/01.EPX.0000465234.31794.b1","article-title":"Pneumococcal infection among hospitalized Egyptian children","volume":"90","author":"Draz","year":"2015","journal-title":"J. Egypt. Public Health Assoc."},{"key":"ref_93","first-page":"316","article-title":"The effects of pneumococcal conjugate vaccine (PCV7 and PCV13) on Turkish children with invasive pneumococcal disease: A single center experience","volume":"115","author":"Erkol","year":"2017","journal-title":"Arch. Argent. de Pediatr."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Chun, B.C., and Noh, H.-O. (2016). Changes of Invasive Pneumococcal Disease Burden in Korea, 2005\u20132014: Analysis of the National Health Insurance Database. Open Forum Infect. Dis., 3.","DOI":"10.1093\/ofid\/ofw172.1136"},{"key":"ref_95","unstructured":"(2018). Pneumococcal Infections in 2017, Japan. IASR, 39, 107\u2013108."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Pennington, K., and The Enhanced Invasive Pneumococcal Disease Surveillance Working Group, for the Communicable Diseases Network Australia (2021, May 01). Invasive Pneumococcal Disease Surveillance, 1 July\u201330 September 2019, Available online: https:\/\/www1.health.gov.au\/internet\/main\/publishing.nsf\/Content\/15C3D92378263DBDCA257C9700814898\/$File\/IPD-jul-sept-2019-Qrt.pdf.","DOI":"10.33321\/cdi.2020.44.40"},{"key":"ref_97","unstructured":"Lopez, L., Heffernan, H., Gilkison, C., and Sherwood, J. (2021, March 15). For the Ministry of Health, New Zealand. Invasive Pneumococcal Disease in New Zealand, 2016. CLIENT REPORT No: FW190193. Available online: https:\/\/surv.esr.cri.nz\/PDF_surveillance\/IPD\/2016\/2016IPDAnnualReport.pdf."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3201\/eid2301.160897","article-title":"Increased Invasive Pneumococcal Disease, North East England, UK","volume":"23","author":"Houseman","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_99","unstructured":"Centers for Disease Control (2021, April 30). Surveillance and Reporting. Pneumococcal Disease, Available online: https:\/\/www.cdc.gov\/pneumococcal\/surveillance.html."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s40121-014-0025-y","article-title":"Epidemiology of pneumococcal disease in a national cohort of older adults","volume":"3","author":"Morrill","year":"2014","journal-title":"Infect. Dis. Ther."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1590\/S1020-49892009000500007","article-title":"Childhood pneumococcal disease burden in Argentina","volume":"25","author":"Augustovski","year":"2009","journal-title":"Rev. Panam. Salud P\u00fablica"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"589","DOI":"10.3201\/eid1904.121198","article-title":"Effect of 10-Valent Pneumococcal Vaccine on Pneumonia among Children, Brazil","volume":"19","author":"Afonso","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Vadlamudi, N.K., Patrick, D.M., Hoang, L., Sadarangani, M., and Marra, F. (2020). Incidence of invasive pneumococcal disease after introduction of the 13-valent conjugate pneumococcal vaccine in British Columbia: A retrospective cohort study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239848"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1080\/21645515.2018.1516491","article-title":"Modeling the sustained use of the 13-valent pneumococcal conjugate vaccine compared to switching to the 10-valent vaccine in Mexico","volume":"15","author":"Wasserman","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_105","unstructured":"Knoll, M.D., Bennett, J., Quesada, M.G., Kagucia, E., Peterson, M., Feikin, D., Cohen, A., Hetrich, M., Yang, Y., and Sinkevitch, J. (2021). Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10\/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project. Microorganisms, 9."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1097\/00006454-200212000-00006","article-title":"Population-based surveillance for hospitalized and ambulatory pediatric invasive pneumococcal disease in Santiago, Chile","volume":"21","author":"Lagos","year":"2002","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Tempia, S., Wolter, N., Cohen, C., Walaza, S., Von Mollendorf, C., Cohen, A.L., Moyes, J., De Gouveia, L., Nzenze, S., and Treurnicht, F. (2015). Assessing the impact of pneumococcal conjugate vaccines on invasive pneumococcal disease using polymerase chain reaction-based surveillance: An experience from South Africa. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1198-z"},{"key":"ref_108","unstructured":"(2021, February 23). Human Papillomavirus and Related Diseases Report. ANDORRA. 17 June 2019. Section 9. Indicators Related to Immunisation Practices Other Than HPV Vaccines. Available online: https:\/\/hpvcentre.net\/statistics\/reports\/AND.pdf."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s41479-018-0053-6","article-title":"Decreased relative risk of pneumococcal pneumonia during the last decade, a nested case-control study","volume":"10","author":"Luna","year":"2018","journal-title":"Pneumonia"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1093\/ofid\/ofw172.602","article-title":"Adults\u2019 Vaccination in Argentina: First-Ever Assessment of Compliance Through A Nationwide Survey","volume":"3","author":"Katz","year":"2016","journal-title":"Open Forum Infect. Dis."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1080\/21645515.2020.1763739","article-title":"Vaccination coverage of recommended vaccines and determinants of vaccination in at-risk groups","volume":"16","author":"Boey","year":"2020","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1586\/14760584.2014.863714","article-title":"Comorbid risk, respondent characteristics and likelihood of pneumococcal vaccination versus no vaccination among older adults in Brazil","volume":"13","author":"Goren","year":"2013","journal-title":"Expert Rev. Vaccines"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1080\/21645515.2019.1708668","article-title":"Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey","volume":"16","author":"Sevilla","year":"2020","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1080\/03009742.2016.1242774","article-title":"Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA)","volume":"46","author":"Nguyen","year":"2017","journal-title":"Scand. J. Rheumatol."},{"key":"ref_115","first-page":"733","article-title":"Prophylaxis against pneumococcal infection after splenectomy: A chal-lenge for hospitals and primary care","volume":"163","author":"Ejstrud","year":"1997","journal-title":"Eur. J. Surg."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s10096-019-03485-3","article-title":"Adult vaccination for pneumococcal disease: A comparison of the national guidelines in Europe","volume":"38","author":"Bonnave","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1093\/eurpub\/ckx150","article-title":"Influenza and pneumococcal vaccination in older adults living in nursing home: A survival analysis on the shelter study","volume":"27","author":"Poscia","year":"2017","journal-title":"Eur. J. Public Health"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/S2213-2600(17)30110-8","article-title":"Effect of high-valency pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries: An observational multicentre study","volume":"5","author":"Savulescu","year":"2017","journal-title":"Lancet Respir. Med."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Jacques, M., Letaief, H., Philippe, G., Xavier, M., Bernard, C., and Lukas, C. (2019). Low Influenza, Pneumococcal and Diphtheria\u2013Tetanus\u2013Poliomyelitis Vaccine Coverage in Patients with Primary Sj\u00f6gren\u2019s Syndrome: A Cross-Sectional Study. Vaccines, 8.","DOI":"10.3390\/vaccines8010003"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.vaccine.2015.01.065","article-title":"Low rate of influenza and pneumococcal vaccine coverage in rheumatoid arthritis: Data from the international COMORA cohort","volume":"33","author":"Hmamouchi","year":"2015","journal-title":"Vaccine"},{"key":"ref_121","first-page":"743","article-title":"Pneumococcal Vaccination Rates in Adults in Germany","volume":"110","author":"Theidel","year":"2013","journal-title":"Dtsch. Aerzteblatt Online"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"212","DOI":"10.12998\/wjcc.v5.i6.212","article-title":"Vaccinations against respiratory infections in Arabian Gulf countries: Barriers and motivators","volume":"5","author":"Alqahtani","year":"2017","journal-title":"World J. Clin. Cases"},{"key":"ref_123","first-page":"326","article-title":"Prevention of pneumococcal infections during mass gathering","volume":"12","author":"Memish","year":"2015","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1080\/21645515.2020.1814653","article-title":"Illness representations on pneumonia and pneumococcal vaccination uptake among community-living Chinese people with high-risk conditions aged \u226565 years\u2014A population-based study","volume":"17","author":"Wang","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1556\/OH.2015.30054","article-title":"Pneumococcal vaccination in general practice","volume":"156","author":"Vajer","year":"2015","journal-title":"Orvosi Hetil."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-0691.2005.01221.x","article-title":"Nationwide study of recurrent invasive pneumococcal infections in a population with a low prevalence of human immunodeficiency virus infection","volume":"11","author":"Kristinsson","year":"2005","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"3657","DOI":"10.1016\/j.vaccine.2016.05.028","article-title":"Low vaccination coverage for seasonal influenza and pneumococcal disease among adults at-risk and health care workers in Ireland, 2013: The key role of GPs in recommending vaccination","volume":"34","author":"Giese","year":"2016","journal-title":"Vaccine"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.3201\/eid2407.170721","article-title":"Pneumococcal Meningitis in Adults after Introduction of PCV7 and PCV13, Israel, July 2009\u2013June 20151","volume":"24","author":"Reisenberg","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1586\/14760584.2016.1166961","article-title":"Pneumococcal conjugate vaccine introduction in Latin America and the Caribbean: Progress and lessons learned","volume":"15","author":"Trumbo","year":"2016","journal-title":"Expert Rev. Vaccines"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"300","DOI":"10.21149\/spm.v55s2.5128","article-title":"Cobertura de vacunaci\u00f3n en adultos y adultos mayores en M\u00e9xico [Vaccination coverage in young, middle age and elderly adults in Mexico]","volume":"55","author":"Enf","year":"2013","journal-title":"Salud Publica Mex."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.reuma.2019.04.004","article-title":"Adherencia a las recomendaciones actuales de inmunizaci\u00f3n en pacientes con artritis reumatoide en M\u00e9xico","volume":"17","author":"Winniczuk","year":"2021","journal-title":"Reumatol. Clin."},{"key":"ref_132","first-page":"14","article-title":"Adult cochlear implant recipients and meningitis in New Zealand: Are patients receiving the recommended immunisations?","volume":"133","author":"Mitchell","year":"2020","journal-title":"N. Z. Med. J."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.5604\/17322693.1176772","article-title":"Pneumococcal and seasonal influenza vaccination among elderly patients with diabetes","volume":"69","author":"Ciebiada","year":"2015","journal-title":"Postepy Hig. Med. Dosw"},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Tawfik, H., Bashwar, Z., Al-Ali, A., Salem, A.M., and Abdelbagi, I. (2015). Improving physician\u2019s adherence to completing vaccination schedules for patients with type 2 diabetes attending non-communicable diseases clinics in West Bay Health Center, Qatar. BMJ Qual. Improv. Rep., 4.","DOI":"10.1136\/bmjquality.u208497.w3388"},{"key":"ref_135","unstructured":"Della Salute, M. (2020, November 05). Piano Nazionale Prevenzione Vaccinale 2017\u20132019, Available online: http:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_2571_allegato.pdf."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2147\/IJGM.S54963","article-title":"Role of pneumococcal vaccination in prevention of pneumococcal disease among adults in Singapore","volume":"7","author":"Setia","year":"2014","journal-title":"Int. J. Gen. Med."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1515\/sjph-2017-0023","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae and serotypes indentified among nursing home residents in comparison to the elderly and patients younger than 65 years living in domestic environment","volume":"56","author":"Paragi","year":"2017","journal-title":"Slov. J. Public Health"},{"key":"ref_138","doi-asserted-by":"crossref","unstructured":"Feldman, C., Dlamini, S.K., Madhi, S.A., Meiring, S., Von Gottberg, A., De Beer, J.C., De Necker, M., and Stander, M.P. (2020). The cost-effectiveness of using pneumococcal conjugate vaccine (PCV13) versus pneumococcal polysaccharide vaccine (PPSV23), in South African adults. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227945"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1743-422X-5-52","article-title":"Effect of influenza and pneumococcal vaccines in elderly persons in years of low influenza activity","volume":"5","author":"Christenson","year":"2008","journal-title":"Virol. J."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/j.ejca.2005.04.027","article-title":"Pneumococcal vaccination in splenectomised cancer patients","volume":"41","author":"Omlin","year":"2005","journal-title":"Eur. J. Cancer"},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13075-015-0663-9","article-title":"Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases\u2014A longitudinal study","volume":"17","author":"Fischer","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"967","DOI":"10.2147\/IJGM.S38472","article-title":"General practitioners\u2019 experiences, attitudes, and opinions regarding the pneumococcal vaccination for adults: A qualitative study","volume":"5","author":"Tandjung","year":"2012","journal-title":"Int. J. Gen. Med."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"e18380","DOI":"10.1097\/MD.0000000000018380","article-title":"Effectiveness of 23-valent pneumococcal polysaccharide vaccine on elderly patients with colorectal cancer","volume":"98","author":"Chiou","year":"2019","journal-title":"Medicine"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"e9773","DOI":"10.1097\/MD.0000000000009773","article-title":"Vaccination coverage and associated factors for receipt of the 23-valent pneumococcal polysaccharide vaccine in Taiwan","volume":"97","author":"Chen","year":"2018","journal-title":"Medicine"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1093\/cid\/ciy1127","article-title":"Successful Control of Streptococcus pneumoniae 19A Replacement with a Catch-up Primary Vaccination Program in Taiwan","volume":"69","author":"Lu","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"2618","DOI":"10.4161\/hv.25826","article-title":"The effect of physicians\u2019 awareness on influenza and pneumococcal vaccination rates and correlates of vaccination in patients with diabetes in Turkey: An epidemiological Study \u201cdiaVAX\u201d","volume":"9","author":"Satman","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/21645515.2018.1489187","article-title":"Immunization rates of pneumococcal, influenza and tetanus vaccines and knowledge and attitudes of adult patients who receive inpatient treatment at hospital: Point prevalence study","volume":"14","author":"Hamidi","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"Ak\u0131n, L., Macab\u00e9o, B., Caliskan, Z., Altinel, S., and Satman, I. (2016). Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157657"},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Costello, R., Winthrop, K.L., Pye, S.R., Brown, B., and Dixon, W.G. (2016). Influenza and Pneumococcal Vaccination Uptake in Patients with Rheumatoid Arthritis Treated with Immunosuppressive Therapy in the UK: A Retrospective Cohort Study Using Data from the Clinical Practice Research Datalink. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153848"},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"19925","DOI":"10.2807\/ese.16.29.19925-en","article-title":"Measles in Italy, July 2009 to September 2010","volume":"16","author":"Filia","year":"2011","journal-title":"Eurosurveillance"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1080\/21645515.2017.1264796","article-title":"Hospitalizations for pneumonia, invasive diseases and otitis in Tuscany (Italy), 2002\u20132014: Which was the impact of universal pneumococcal pediatric vaccination?","volume":"13","author":"Boccalini","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_152","unstructured":"(2020, July 04). Cases of COVID-19 per 100K in Italy as of 4 July 2020. Available online: https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e6\/COVID-19_outbreak_Italy_per_capita_cases_map.svg\/460px-COVID-19_outbreak_Italy_per_capita_cases_map.svg.png."},{"key":"ref_153","unstructured":"Centers for Disease Control (2020, November 09). 2017 Childhood Pneumococcal Conjugate Vaccine (PCV) Coverage Report, Available online: https:\/\/www.cdc.gov\/vaccines\/imz-managers\/coverage\/childvaxview\/data-reports\/pcv\/reports\/2017.html."},{"key":"ref_154","unstructured":"Centers for Disease Control (2020, November 09). Pneumococcal Vaccination Coverage Among Adults 18\u201364 Years at Increased Risk and \u226565 Years, Td and Tdap Vaccination Coverage Among Adults \u226518 Years, and Shingles Vaccination Coverage Among Adults \u226560 Years by Selected Local Area, State, HHS Region, and the United States, BRFSS, 2008 through 2017, Available online: https:\/\/www.cdc.gov\/vaccines\/imz-managers\/coverage\/adultvaxview\/data-reports\/general-population\/trend\/index.html."},{"key":"ref_155","unstructured":"Centers for Disease Control and Prevention (2006). Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years\u2014United States, 2004\u20132005. MMWR Morb. Mortal. Wkly. Rep., 55, 1065\u20131068."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S0006-3223(98)00043-2","article-title":"Multiple correlations and bonferroni\u2019s correction","volume":"44","author":"Curtin","year":"1998","journal-title":"Biol. Psychiatry"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1086\/375782","article-title":"Effectiveness of the 23-Valent Polysaccharide Vaccine against Invasive Pneumococcal Disease in Navajo Adults","volume":"188","author":"Benin","year":"2003","journal-title":"J. Infect. Dis."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.vaccine.2015.09.031","article-title":"Racial and ethnic disparities in vaccination coverage among adult populations in the U.S.","volume":"33","author":"Lu","year":"2015","journal-title":"Vaccine"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.vaccine.2019.01.084","article-title":"Race-related differences in functional antibody response to pneumococcal vaccination in HIV-infected individuals","volume":"37","author":"Happe","year":"2019","journal-title":"Vaccine"},{"key":"ref_160","unstructured":"Centers for Disease Control (2020, December 13). Vaccination Coverage among Adults in the United States, National Health Interview Survey, Available online: https:\/\/www.cdc.gov\/vaccines\/imz-managers\/coverage\/adultvaxview\/pubs-resources\/NHIS-2016.html#pneumo."},{"key":"ref_161","unstructured":"Centers for Disease Control (2021, March 17). Risk for COVID-19 Infection, Hospitalization, and Death by Race\/Ethnicity, Available online: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/covid-data\/investigations-discovery\/hospitalization-death-by-race-ethnicity.html."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"5355","DOI":"10.1016\/j.vaccine.2011.05.086","article-title":"The epidemiologic evidence underly-ing recommendations for use of pneumococcal polysaccharide vaccine among American Indian and Alaska Native populations","volume":"29","author":"Said","year":"2011","journal-title":"Vaccine"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"e1186","DOI":"10.1542\/peds.2015-1773","article-title":"Racial and regional differences in rates of invasive pneumococcal disease","volume":"136","author":"Grijalva","year":"2015","journal-title":"Pediatrics"},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/01.inf.0000148891.32134.36","article-title":"Population-based surveillance for childhood invasive pneumococcal disease in the era of conjugate vaccine","volume":"24","author":"Hsu","year":"2005","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/00333549111260S313","article-title":"Changing disparities in invasive pneumococcal disease by socioeconomic status and race\/ ethnicity in Connecticut, 1998\u20132008","volume":"126","author":"Soto","year":"2011","journal-title":"Public Health Rep."},{"key":"ref_166","doi-asserted-by":"crossref","unstructured":"Intra, J., Besana, S., Savarino, C., and Brambilla, P. (2017). Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Invasive Isolates Collected at the Italian Hospital of Desio, Lombardy, from 2008 to 2016. Front. Public Health, 5.","DOI":"10.3389\/fpubh.2017.00169"},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/cid\/ciaa1728","article-title":"Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Invasive Pneumococcal Disease and Risk of Pneumococcal Coinfection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Prospective National Cohort Study, England","volume":"72","author":"Aiano","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"699","DOI":"10.4161\/hv.23268","article-title":"Cost-effectiveness of new adult pneumococcal vaccination strategies in Italy","volume":"9","author":"Boccalini","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_169","doi-asserted-by":"crossref","unstructured":"Orsi, A., Ansaldi, F., Trucchi, C., Rosselli, R., and Icardi, G. (2016). Pneumococcus and the Elderly in Italy: A Summary of Available Evidence Regarding Carriage, Clinical Burden of Lower Respiratory Tract Infections and On-Field Effectiveness of PCV13 Vaccination. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17071140"},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s40520-019-01145-2","article-title":"Calabria: A successful experience implementing Herpes Zoster vaccination strategies","volume":"31","author":"Giuffrida","year":"2019","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_171","doi-asserted-by":"crossref","unstructured":"Baldo, V., Cocchio, S., Gallo, T., Furlan, P., Romor, P., Bertoncello, C., Buja, A., and Baldovin, T. (2016). Pneumococcal Conjugated Vaccine Reduces the High Mortality for Community-Acquired Pneumonia in the Elderly: An Italian Regional Experience. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166637"},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1080\/21645515.2019.1661754","article-title":"Determinants of vaccination uptake, and influenza vaccine effectiveness in preventing deaths and hospital admissions in the elderly population; Treviso, Italy, 2014\/2015-2016\/2017 seasons","volume":"16","author":"Bellino","year":"2020","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1016\/j.ajic.2009.09.019","article-title":"Eight years of active proposal of pneumococcal 23-valent polysaccharide vaccine: Survey on coverage rate among elderly and chronic patients","volume":"38","author":"Martinelli","year":"2010","journal-title":"Am. J. Infect. Control."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ijid.2019.12.021","article-title":"Associations between geographic region and immune response variations to pneumococcal conjugate vaccines in clinical trials: A systematic review and meta-analysis","volume":"92","author":"Choe","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.vaccine.2019.10.005","article-title":"Influenza vaccination and respiratory virus interference among Department of Defense personnel during the 2017\u20132018 influenza season","volume":"38","author":"Wolff","year":"2020","journal-title":"Vaccine"},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1126\/science.abd3871","article-title":"Selective and cross-reactive SARS-CoV-2 T cell epitopes in unexposed humans","volume":"370","author":"Mateus","year":"2020","journal-title":"Science"},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1038\/s41586-020-2598-9","article-title":"SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19","volume":"587","author":"Braun","year":"2020","journal-title":"Nature"},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/j.cell.2020.05.015","article-title":"Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals","volume":"181","author":"Grifoni","year":"2020","journal-title":"Cell"},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-020-75972-z","article-title":"Epitope similarity cannot explain the pre-formed T cell immunity towards structural SARS-CoV-2 proteins","volume":"10","author":"Stervbo","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"6631","DOI":"10.1172\/JCI143120","article-title":"Healthy donor T cell responses to common cold coronaviruses and SARS-CoV-2","volume":"130","author":"Woldemeskel","year":"2020","journal-title":"J. Clin. Investig."},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1016\/j.immuni.2020.11.016","article-title":"Low-Avidity CD4+ T Cell Responses to SARS-CoV-2 in Unexposed Individuals and Humans with Severe COVID-19","volume":"53","author":"Bacher","year":"2020","journal-title":"Immunity"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S1473-3099(19)30410-4","article-title":"Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: An analysis for the Global Burden of Disease Study 2017","volume":"20","author":"Troeger","year":"2020","journal-title":"Lancet Infect. Dis."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/5\/474\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:58:10Z","timestamp":1760162290000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/5\/474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,8]]},"references-count":182,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["vaccines9050474"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9050474","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,8]]}}}