Adherence of healthcare workers to pneumococcal vaccination in adults at risk

Relevance. Pneumococcal infection remains one of the common causes of morbidity and mortality worldwide, including among at-risk adults and the elderly. Vaccination is the most effective preventive measure. However, vaccination coverage among at-risk adults in the Russian Federation remains insufficient, which may be related, among other factors, to low public awareness about the possibility of immunization and to low physician adherence to pneumococcal vaccination. At present, data on this indicator in Russia are limited.

Aim. To assess physician adherence to pneumococcal vaccination among at-risk adults.

Materials and Methods. A sample-based prospective observational epidemiological study was conducted, comprising four data collection phases (2019, 2021, 2023, 2025). Data were collected using an anonymous questionnaire. Physicians specializing in the treatment, prevention, and counseling of high-risk adult patients for pneumococcal infection (internists, general practitioners, pulmonologists, cardiologists, endocrinologists, etc.) were invited to participate. Invitations were sent using the database of the National Association of Specialists in Control of Infectious and Non-Infectious Diseases (NASСI). A total of 27,082 respondents participated (8,695 in 2019, 9,032 in 2021, 4,305 in 2023, and 5,050 in 2025). Representatives from 79 out of 85 federal subjects participated in 2019 and 2021, 66 out of 89 in 2023, and 70 out of 89 in 2025. Statistical analysis employed descriptive statistics. Correlation analysis was performed to identify associations between adherence to vaccination and pneumococcal vaccination coverage in specific risk groups, with a significance level of p < 0.05.

Results. In 2025, 64.3 % [CI: 63–65.6 %] of physicians reported recommending pneumococcal vaccination. Between 2019 and 2021, this indicator decreased from 64.4 % [CI: 63.4–65.4 %] in 2019 to 58.6 % [CI: 57.6–59.6 %] in 2021. Vaccination was recommended to patients with chronic bronchopulmonary diseases by 91.1 % of physicians overall [CI: 90.4–91.8 %], including 96.7 % [CI: 93.8–99.6 %] of pulmonologists, 92.7 % [CI: 91.6–93.8 %] of internists, and 91.7 % [CI: 89.4–94 %] of infectious disease specialists. For individuals aged ≥ 60 years, 81.8 % [CI: 80.8–82.8 %] of physicians overall recommended vaccination, including 90.5 % [CI: 81.6–99.5 %] of geriatricians, 75.6 % [CI: 71.9–79.3 %] of general practitioners, and 71.1 % [CI: 69.2–73 %] of internists. Approximately half of physicians recommended vaccination to patients with chronic cardiovascular diseases (62.0 % [CI: 60.7–63.3 %] overall; 67.4 % [CI: 62.3–72.5 %] among cardiologists) and endocrine diseases (56.8 % [CI: 55.5–58.1 %] overall; 77.0 % [CI: 72.4–81.6 %] among endocrinologists). The smallest proportion of specialists (less than one quarter) reported recommending pneumococcal vaccination to patients with chronic kidney disease (15.0 % [CI: 14.1–15.9 %] overall; 44.9 % [CI: 31–58.8 %] among nephrologists), liver disease (17.8 % [CI: 16.8–17.8 %] overall), and immunocompromised patients (24.9 % [CI: 23.8–26.0 %] overall; 84.8 % [CI: 72.6–97 %] among hematologists, 60.3 % [CI: 56.3–64.3 %] among infectious disease specialists, and 38.6 % [CI: 32.8–44.4 %] among oncologists). From 2019 to 2025, the proportion of physicians recommending vaccination to individuals aged ≥ 60 years increased by 21.8 %, and to patients with chronic cardiovascular diseases by 19.9 %. Less pronounced growth was observed for patients with endocrine diseases and workers in occupations harmful to the respiratory system (by 7.1 % and 8.4 %, respectively). The proportion of physicians recommending vaccination to individuals in special living conditions (e.g., shift workers), immunocompromised patients, and patients with chronic liver or kidney diseases did not increase and remained low. A direct, strong, statistically significant correlation was found between the level of vaccination adherence in 2023 and 2025 and the increase in pneumococcal vaccination coverage among at-risk adults (r = 0.77, p = 0.005 and r = 0.72, p = 0.013, respectively). A direct, statistically significant correlation of moderate strength was found between adherence in 2023 and vaccination coverage in 2023 (r = 0.59, p = 0.021).

Conclusion. Further efforts are needed to improve physician awareness regarding pneumococcal vaccination, specifically: incorporating detailed information on specific prophylaxis into clinical guidelines for managing high-risk patients, including immunization strategies, schedules, timing, and efficacy data; expanding the list of individuals eligible for vaccination under the National Immunisation Schedule and the Vaccination Schedule for Epidemic Indications; and actively involving in educational activities on immunoprophylaxis those clinicians who treat high-risk patients and prevent infectious diseases among them.

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