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incidence rate ratios (IRR) were calculated using Poisson regression



In the DM cohort, a total of 1,783 HZ cases accrued over

227,918 person-years of follow up. In DM cohort with HZ, a total of 222

PHN cases accrued over 2,048 person-years of follow up. After

controlling for age, sex, comorbidity index, immunosuppression and

US region, the HZ IRR for patients with DMT2 vs. NDM was 1.16 (95%

CI = 1.10,1.21, p < 0.001). When stratified by age, patients with DMT2

had significantly higher HZ rate than NDM among both patients aged


59 (1.21, 95%CI = 1.13, 1.29, p < 0.001) and aged 60+ (1.09, 95%

CI = 1.02, 1.17, p = 0.013).


Overall, HZ incidence rate is 16% higher in patients with

DMT2 than in NDM. Among patients aged 18

59, however, HZ rate is

21% higher for patients with DMT2 than for NDM.


23-Valent pneumococcal polysaccharide vaccine produces

comparable antibody response following primary and

revaccination in adults 70 to 89 years old

K. Kawakami, H. Kishino, S. Kanazu, N. Toshimizu, R. Yokokawa,

K. Takahashi, M. Kohn, L. Musey.

Nagasaki Kawatana Medical Center,

MSD K. K., Tokyo, Japan; Merck & Co., Inc., Kenilworth, NJ, USA


Despite increasing risk for pneumococcal disease with

advancing age, many countries recommend only a single dose of

pneumococcal polysaccharide vaccine (PPSV23) for older adults.

Concerns about the possibility of declining response to revaccination

with age have hindered the adoption of a revaccination policy. We

examined antibody responses by age after primary vaccination and

revaccination in a cohort of adults aged 70

89 years.


We measured serotype-specific IgG geometric mean

concentrations (IgG, 14 serotypes) and opsonophagocytic activity

geometric mean titers (OPA, 6 serotypes) 4 weeks after vaccination in a

community-based cohort vaccinated > = 5 years earlier (N = 161) or

never vaccinated (N = 81) with PPSV23. Subjects were aggregated into

4 groups using 5-year age increments for analysis.


Across age groups IgG and OPA in the primary vaccination and

revaccination groups were not significantly different. Within each age

group and for all serotypes there were no significant differences

between the primary and revaccination groups, with the exception

of the group aged 70

74 for which IgG for serotypes 23F and 19A and

OPA for serotype 6B were higher in the primary vaccination group than

the revaccination group.


IgG and OPA after PPSV23 did not decline with age

between 70 and 89 years. For all age groups, patients responded

similarly to primary and revaccination. The generally comparable

levels of IgG and OPA for the serotypes tested after primary vaccination

and revaccination regardless of age supports the value of revaccination

with PPV23, even to older adults.


Multidisciplinary team meetings and management checklist

improves management of patients with Clostridium difficile

infection: a United Kingdom experience

K.Y. Law, H. Petkar, M. Gonzalez Sanz.

North Middlesex University

Hospital NHS Trust, London, United Kingdom


Clostridium difficile infection (CDI) is associated with

considerable morbidity and mortality especially in elderly patients

who are prone to electrolyte imbalance, dehydration andmalnutrition.

In the United Kingdom, the Department of Health has called for a

multidisciplinary approach to improve the care of patients with CDI. In

a London district general hospital, we aimed to establish whether

compliance to standards of management of CDI improves with the

implementation of regular multidisciplinary team (MDT) meetings

and management checklists in 2015.


We conducted a retrospective review of medical records and

pathology results of patients with CDI in 2013 and 2015. A total of 89

episodes from 76 patients were analysed.



s demographics were similar in both years


patients were male. Median age of patients with CDI is 78. 40

49% of

cases were hospital acquired. Over 60% of cases were mild to moderate

in severity. Elderly patients were more prone to relapse of disease

(12%). 30-day mortality among patients with CDI was 25


The implementation of regular MDT meetings and management

checklists have brought significant improvement in severity assess-

ment and CDI treatment compliance (82% v 69%) and improved

documentation of severity (36% v 8%). There is also improvement in

review of antibiotics (93% v 83%), PPIs (78% v 53%) and the rate of

nutritional review (85% v 54%).


We demonstrate that regular MDT meetings and mana-

gement checklists can improve compliance to standards of manage-

ment of CDI and transform clinical care for elderly patients with CDI.


Massive hematochezia in an elderly patient

M.M. Luis, A.A. Sousa, M. Oliveira, R. Verissimo, C. Rozeira, A. Oliveira,

V. Paixão Dias.



Albeit common in the immunocompromised,

Cytomegalovirus (CMV) disease of the gastrointestinal tract is rare in

the immunocompetent. Symptoms and endoscopic features are not

well recognized. Case description. 87 year-old woman. Katz A. Medical

history of Hypertension. Admitted at the Orthogeriatrics Unit,

after closed reduction of femur fracture. No intra-operatory com-

plications. Good health status. Hemodynamic stability. Apyrexia. First

post-operative day: hyperactive delirium, compromising functional

rehabilitation start. Sixth post-operative day: fever. Considering

progressive global status deterioration, cultures were performed.

Antibiotic treatment was started. Surgical site, pulmonary and

urinary infection were excluded. Malaise and diarrhea. Clostridium

difficile and other enteric pathogens were excluded. Leucocytes

were identified in feces. Abdominal echography OK. Negative cultural

exams, including coprocultures. Eighteenth post-operative day:

hematochezias, requiring transfusion. Angio-CT scan excluded

ischemic colitis. Negative immunologic screen. Low sed rate.

Colonoscopy: infectious colitis. HV negative. Ciprofloxacin and

metronidazol were started. Intestinal biopsy with intranuclear inclu-


compatiblewith CMV infection. Ganciclovir treatment resolved

symptoms. No relapse.


Klauber et al found association between hospitalization

and CMV infection in 1/3 of the geriatric patients. Major surgery is a

risk factor. The elderly may be more susceptible to this infection due to

immunitary changes associated with age.


National funding for 23-valent pneumococcal polysaccharide

vaccine for adults aged 65+ in G20 countries

M.A. Kohn, J.G. Grabenstein.

Merck & Co, Inc.


In August 2014 the US Advisory Committee on

Immunization Practices (US ACIP) changed the recommended

pneumococcal vaccines for adults 65+ from 23-valent polysaccharide

vaccine (PPV23) alone to a regimen of 13-valent pneumococcal

conjugate vaccine (PCV13) followed by PPV23. The ACIP has stated

that they plan to reevaluate this recommendation in 2018. We

sought to identify whether similar policy changes were adopted by

other high income countries, and the reasons for their doing or not

doing so.


Using internet searches and communication with experts

we assessed the Group of 20 (G20) countries for publicly funded

adult pneumococcal vaccination programs, the cohorts funded, and

published reasons for each country

s decision.


To date nine G20 countries do not publicly fund pneumo-

coccal vaccination for adults, and other than the US only seven publicly

fund pneumococcal vaccination for adults age 65+; all seven fund

PPV23 alone. Only the US funds a sequential regimen for this group.

Published reasons for not funding sequential vaccination for this

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