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38,500 deaths estimated to occur each year in the

EU/EEA countries with 90% in seniors. In France, during 2014



30,000 cases admitted to intensive care units for influenza

resulting in 3133 hospitalisations (47% in 65+) and excess all-cause

mortality of 18,300 individuals (90% in 65+) reported. Same trend

in most EU countries. Pneumococcal diseases: 20,785 confirmed

cases of invasive pneumococcal disease reported by 27 EU/EEA

countries in 2012, predominantly in seniors. Zoster: more than 1.7

million new cases all ages each year in Europe, risk and severity

increasing with age. Diphteria: in 2012, 27 cases of diphtheria reported

by 8 EU/EEA countries, the majority being in seniors. Tetanus: In 2012,

123 cases reported, 80% in seniors. Pertussis: in 2012, 42,525 cases

reported by 28 EU/EEA countries. Incidence is increasing in adoles-

cents and adults and gives reasons for concern of transmission to

infants. Polio: no case in any of the 29 reporting EU/EEA countries

in 2012.


With an ageing European population, these data support

a strong public health rationale for preventing influenza, pneumococ-

cal diseases and zoster in seniors, all these diseases being of higher and

substantial incidence and severity in this age group.


Gastrointestinal infections and the use of proton pump inhibitors

in a geriatric population

I. Figueiredo, G. Magalhães, A.M. Antunes, H. Gruner, A. Panarra.

Serviço Medicina 7.2

Hospital Curry Cabral, CHLC

Gastroenteritis (GE) has a high case-fatality ratio in the elderly . It is

associated with nursing homes and antibiotics , but chronic use of

proton pump inhibitors (PPI) has also been related to it. One of the

major adverse effects is dehydration, predisposed by atherosclerosis,

but increased mortality should also be considered . A retrospective

descriptive study was carried out, including patients admitted to a

medical ward with the diagnosis of GE, during a 5-year-period.

Patients were characterised according to gender, age and Charlson

Comorbity Index (CCI). The endpoints were PPI use, previous use of

antibiotics, antibiotic given for GE, dehydration, intensive care unit

(ICU) admission, mortality and readmission at 1 month. During this

period, 96 patients were admitted. 58% were female, with an average

age of 81.03 years. Male patients had an average age of 78.35 years and

a higher CCI (7.6 vs 5.8 for females; 6.6 global). More than half (55%)

used PPI chronically and 15% had been previously treated with

antibiotics. An agent was identified in only 6.25%, but 45% were treated

with antibiotics: ciprofloxacin (39%), cephalosporins (25%), metro-

nidazole (18%), amoxicillin (9%), vancomycin (7%), macrolides (6.7%)

and piperacillin/tazobactam (4.5%). Dehydration was present in 60% of

patients, 3% needed ICU admission, 5% died and 15% were readmitted

in the following month. Our results are similar to previous studies,

which demonstrates the importance of PPI and antibiotics use before

acute GE. The extensive use of antibiotics in this setting might be

counterproductive, as agents are seldom identified.


Healthcare resource utilization and costs associated with herpes

zoster in the United States

B.H. Johnson


, L. Palmer


, J. Gatwood


, G. Lenhart


, K. Kawai


, K.

D. Johnson


, C.J. Acosta




Truven Health Analytics, Boston, MA,


University of Tennessee, Knoxville, TN,


Harvard Medical School, Boston,



Merck & Co., Inc., Center for Observational and Real World Evidecnce

(CORE), Kenilworth, NJ, USA


Herpes zoster continues to have a significant financial

impact on the U.S. healthcare system. The objective of this study was to

evaluate the economic burden of herpes zoster (HZ) on the US

healthcare system among an immunocompetent population.


Claims data from the MarketScan


Research databases for


2011 were extracted to determine the incremental healthcare

resource utilization (RU) and direct medical costs associated with HZ.

Immunocompetent HZ-patients were identified and directly matched

1:1 with immunocompetent non-HZ controls using demographic and

clinical variables. Analysis was limited to claims 21 days prior to

through the first year following HZ diagnosis. Cases with post-herpetic

neuralgia (PHN) were analyzed separately.


In total, 98,916 HZ-patients were matched to controls. HZ-

patients had a mean age of 50.4 (SD: 18.8) years and 56.6% were

females. HZ-cases had significantly higher RU (0.016 inpatient visits,

0.153 ER visits, 2.116 outpatient office visits and 3.730 other outpatient

services) compared to controls (p < 0.001). Differences increased

substantially in the presence of PHN. Total mean incremental

healthcare costs for HZ-cases were $1,308 and quadrupled to $5,463

in those with PHN (both p < 0.001). Overall, primary cost drivers were

outpatient prescriptions and other outpatient services. For those with

PHN, inpatient services also played a significant role.


HZ presents a significant economic and resource burden

on the US healthcare system among immunocompetent patients of

nearly all ages, particularly when complicated by PHN.


Infections in elderly patients

L. Jordanovski


, J. Jakimovska


, L. Neloska




PHI Gerontology Institute 13

November, Skopje, Republic of Macedonia


With the growth of elderly population we need to be

familiar with infectious diseases because they can increase mortality.

Thus is due to the changes in immune system, different epidemiology

and bacteriology and different clinical presentation of the infection.

The most common infections in adults are pneumonia, infections of

the urinary system, pressure ulcer, infectious diarrhoea, fever of

unknown origin etc. Viral infections are less common. During the

treatment we should use drugs which give fewer side effects in elderly



We designed cross match study which aim was to show

types of infection and use of antibiotics in elderly patients during one

week in PHI Gerontology Institute 13 November as institution that

hospitalize patients aged over 65 with chronic progressive disease.


During one week in February in our hospital 234 patients

were hospitalized with an average age of 78 years, 34 patients (14.5%)

were diagnosed with infection mostly on the respiratory system

(55.9%), urinary system (20.6%), pressure ulcer (14.7%), digestive

system (5.9%). For treatment of this infectious most widely used

antibiotic were cephalosporines (43.3%), fluoroquinolones (22.8%),

sulphonamides (9.1%). 85% of the patients were on one antibiotic.


In adult population we should take infections seriously

because some clinical evidence for occurrence of a disease can be

missing. Laboratory analyzes can show different variations in ESR, CRP

and leukocyte count. We need to take a good history and other clinical

investigations. We should use empirical antibiotic with broad

spectrum and few side effects.


Diabetes mellitus as risk factor for herpes zoster in United States


C. Newransky


, J. Mao


, K. Kawai


, B. Gebremeskel


, J.T. McPheeters



K.D. Johnson


, C.J. Acosta




Merck Co. & Inc., Center for Observational

and Real World Evidence (CORE), Kenilworth, NJ,


Optum, Eden Prairie,



Harvard Medical School, Boston, MA, USA


Diabetes mellitus (DM) has been associated with an

increased risk of HZ. This study improves on previous research by using

a nationwide database to assess DM as a risk factor for HZ.


Data for this retrospective cohort study was extracted

from commercial and Medicare Advantage plans in Optum claims

databases for adults aged

18 who had at least 12 months of

continuous enrollment. The DM cohort consisted of enrollees with

1 two claims with diagnosis code for diabetes (ICD-9-CM:


) in


2011. Incident HZ cases were patients with

1 claim with a

diagnosis code for HZ (ICD-9-CM: 053.0

053.11, 053.14

053.9) in any

position. Crude and adjusted HZ incidence by DM status and adjusted

Poster presentations / European Geriatric Medicine 7S1 (2016) S29