Influenza Season Triggers Pneumococcal Vaccination Lynne J. Goebel, MD, and Maurice A. Mufson, MD OBJECTIVES: To investigate the frequency with which influenza and pneumococcal vaccines are administered alone and together. DESIGN: Retrospective review. SETTING: Marshall University internal medicine practice, Huntington, West Virginia. PARTICIPANTS: All patients aged 65 and older seen in the practice from 1999 through 2005 who received pneumo- coccal or influenza vaccine. MEASUREMENTS: Billing records were reviewed for administration of pneumococcal and influenza vaccines to Medicare beneficiaries, and rates of administration of these vaccines given alone and together were calculated. RESULTS: Nine hundred sixty-nine doses of pneumococ- cal vaccine were administered. Of these, 796 (82%) were administered during the fall and winter. Three hundred fif- ty-six (45%) pneumococcal vaccinees received it together with influenza vaccine. During 2001 and 2005, when in- fluenza vaccine supply was limited, the rate of pneumo- coccal vaccine administered together with influenza vaccine declined sharply. Nonetheless, the rate of pneumococcal vaccination remained relatively stable because of an in- crease in the rate of vaccine administered alone. CONCLUSION: Four-fifths of pneumococcal vaccine was administered in the fall and winter, and approximately half was given together with influenza vaccine. When influenza vaccine was in limited supply, physicians continued to vac- cinate with pneumococcal vaccine alone. These findings suggest that the imminent influenza season provides the trigger for physicians to prescribe pneumococcal vaccine. Physicians should be reminded that pneumococcal vaccine can be administered any time of year. J Am Geriatr Soc 54:1261–1264, 2006. Key words: pneumococcal vaccine; influenza vaccine; simultaneous vaccination S ince the 1990s, the Centers for Disease Control and Prevention (CDC) has recommended that physicians administer influenza and pneumococcal vaccines at the same time to patients eligible for both vaccines as one ap- proach to increase the frequency of pneumococcal vacci- nation. 1 Although the results of several studies support the safety and efficacy of both vaccines when administered to- gether, 2–4 one in each arm, no evidence was found about the frequency with which these vaccines are administered to- gether in practice to persons aged 65 and older, the group at highest risk of serious influenza and pneumococcal diseases. To address this, the frequency with which pneumococcal and influenza vaccines were administered together to Medi- care beneficiaries treated in the internal medicine ambula- tory practice of Marshall University Joan C. Edwards School of Medicine over a 6-year period was investigated. METHODS The billing records of patients aged 65 and older were reviewed by epidemiological year (July 1 to June 30) from 1999 through 2005 for administration of pneumococcal and influenza vaccines in the university internal medicine ambulatory care practice. The billable Medicare codes were searched for influenza (G0008) and pneumococcal (G0009) vaccines to identify vaccinees. Annual rates of administra- tion of pneumococcal and influenza vaccines given alone and together were calculated using as the denominator for influenza vaccine all patients aged 65 and older treated in the ambulatory practice each epidemiological year. How- ever, because pneumococcal vaccine is recommended only one time for all persons aged 65 and older, a corrected de- nominator was used each epidemiological year of only vac- cine-eligible persons aged 65 and older, which excluded patients who had received the pneumococcal vaccine in the practice offices any time in the 10 years before the start of this study and patients who received pneumococcal vaccine in successive years of this study. Dichotomous data were compared using Fisher exact test for independent samples (available at http://faculty.vassar.edu/lowry/VassarStats. html). 5 The Marshall University institutional review board approved this study. RESULTS Over the 6 years of this study, 969 doses of pneumococcal vaccine were administered, and of these, 796 (82.1%) were administered during the fall and winter (Table 1). Three Address correspondence to Lynne J. Goebel, MD, 1600 Medical Center Drive, Suite G500, Huntington, WV 25701. E-mail: goebel@marshall.edu DOI: 10.1111/j.1532-5415.2006.00810.x From the Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia. JAGS 54:1261–1264, 2006 r 2006, Copyright the Authors Journal compilation r 2006, The American Geriatrics Society 0002-8614/06/$15.00