181 / 290
incidence rate ratios (IRR) were calculated using Poisson regression
models.
Results:
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
18
–
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).
Conclusions:
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.
P-553
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
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
P-554
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
Objectives:
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.
Method:
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.
Results:
Patient
’
s demographics were similar in both years
–
50%
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
–
31.2%.
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%).
Conclusion:
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.
P-555
Massive hematochezia in an elderly patient
M.M. Luis, A.A. Sousa, M. Oliveira, R. Verissimo, C. Rozeira, A. Oliveira,
V. Paixão Dias.
CHVNGE
Introduction:
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-
sions
–
compatiblewith CMV infection. Ganciclovir treatment resolved
symptoms. No relapse.
Conclusions:
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.
P-556
National funding for 23-valent pneumococcal polysaccharide
vaccine for adults aged 65+ in G20 countries
M.A. Kohn, J.G. Grabenstein.
Merck & Co, Inc.
Background:
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.
Methods:
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.
Results:
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
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