Barriers and facilitators of pneumococcal vaccination among the elderly

Despite the burden of disease caused by pneumococcus, adult immunization rates are modest. To understand barriers in diverse settings, we surveyed patients age ≥66 years at: (1) inner-city health centers; (2) Veterans Affairs (VA) outpatient clinics; (3) rural practices; and (4) suburban practices. Among the 1007 respondents, self-reported pneumococcal vaccination rates were: 85% VA; 62% rural; 66% suburban; and 57% inner-city with substantial variability among practices. Half of the unvaccinated (50%) did not know they needed vaccination. Most vaccinees (90%) thought that their doctor believed they should be vaccinated, compared with 23% of the unvaccinated ( P