1797. Pneumococcal Vaccination in Veterans 65 years and older with Pneumococcus in the Veterans Health Administration (VHA) since November 2021

Abstract Background Pneumococcal infection is a vaccine-preventable illness caused by Streptococcus pneumoniae. In October 2021, the Advisory Committee on Immunization Practices updated pneumococcal vaccine guidelines in all adults >65 years and for adults 19-64 years with certain medical conditions or risk factors. Pneumococcal vaccination among patients >65 years is a national VHA performance measure. We reviewed vaccine status in patients >65 years with pneumococcal infection since guidelines changed. Methods Demographics, pneumococcal vaccination in relation to time of infection and laboratory testing (culture, molecular and urinary antigen) during 11/1/2021-4/11/2023 were retrieved from VHA data sources. Patients aged >65 years with pneumococcus were evaluated and compared to VHA’s electronic quality measurement (eQM) for national pneumococcal vaccination rates. Results 1,128 cases (1,108 unique patients) were identified (Table 1). 20 patients had recurrent infections. Median age was 74 years (IQR 69-77) with non-Hispanic Blacks (14.1%) slightly overrepresented compared to VHA’s Black population (12.7%); primary infection sites were pulmonary (68.4%) and blood (23.5%). 1,006/1,128 (89.2%) of cases in patients >65 years had at least 1 pneumococcal vaccine. VHA’s national pneumococcal vaccination of patients >65 years for fiscal years 2022-23 was 65.3%-65.9% per eQM. Of cases not vaccinated, 22.1% were non-Hispanic Black patients. Median time of vaccination before infection was 4.7 years (IQR 2.8-6.5). Most recent vaccination prior to infection for the overall cohort and those with recurrent infections was 23-valent pneumococcal polysaccharide vaccine (PPSV23) (56.5% and 57.9% respectively). In addition, 108/1,128 (9.6%) cases were vaccinated after their pneumococcal infection (17/108 were not previously vaccinated). 71/108 (65.7%) vaccines given after illness were 20-valent pneumococcal conjugate vaccine (PCV) (PCV20). Conclusion In VHA patients >65 years with pneumococcal infection, nearly 90% had had at least 1 pneumococcal vaccine which was mainly PPSV23 and given on average almost 5 years before infection. VHA could target non-Hispanic Black patients with pneumococcal vaccination efforts and ensure providers are utilizing PCV20 or PCV15+PPSV23 vaccines. Disclosures All Authors: No reported disclosures