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group include the declining incidence of PCV13-serotype disease

in older adults secondary to infant immunizationwith PCV13, and lack

of evidence for cost effectiveness or effectiveness of a sequential



To date none of the G20 countries with national funding

programs for pneumococcal vaccination of adults aged 65 and

older have adopted the change made by the US ACIP in 2014 for

this group. Reasons cited for this include the declining incidence of

PCV13-serotype disease in older adults, and lack of evidence for cost



Infectious aortitis: a difficult diagnosis which requires a high level

of suspicion

P. Muhamed


, S. Henneberg Pedersen




Holbaek Hospital, Holbaek,



Infectious aortitis is a rare condition defined as

inflammation of the aorta caused by microorganisms. If left untreated

it can be lethal or complicated with development of aneurysms,

dissection, fistula or rupture of the aorta [1

3]. The aorta is normally

very resistant to infection [1]. Risk factors for infectous aortitis include

atherosclerosis, age above 50 years, trauma or aorta graft, impaired

immunity, diabetes mellitus, or congenital aortic anomalies [1, 2]. It is

a diagnosis that is difficult to make. Computed tomography (CT) is the

imaging study of choice in diagnosing infectious aortitis, however

small vegetations may be missed. Other diagnostic tools are Magnetic

resonance imaging (MRI) and Positron emission tomography (PET) CT

scan [1


Methods and results:

We present two cases, a 78 years old male

treated for E. coli and Pneumococcus septicaemia and a 71 years old

female treated for staphylococcus septicaemia. Their general condition

worsened despite of initial treatment with antibiotics. PET- CT

scanning revealed diffused aortitis. Both were treated with antibiotics

for more for than one year and their condition improved.


Infectious aortitis should always be considered in elderly

patients with atherosclerosis, a persistent and unexplained history

of fever, thoracic, abdominal, or back pain with or without positive

blood culture [1, 2].


1. Foote EA, Postier RG, Greenfield RA

et al.

Infectious aortitis.


Treat Options Cardiovascular Med



2. Lopes RJ, Almeida J, Dias PJ

et al.

Infectious thoracic aortitis:

A literature review.

Clin Cardiol



3. Mohan N, Kerr G. Aortitis.

Curr Treat Options Cardiovascular Med




Herpes zoster and diabetes: more and more

C. Muñoz-Quiles, M. López-Lacort, J. Díez-Domingo.

Vaccine Research,

Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la

Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain


The objective of this study was to asses the risk of

Herpes Zoster (HZ) in diabetics compared with non-diabetics and the

risk of negative impact of HZ on diabetes.


A retrospective cohort of all HZ patients aged over 49

years between 2009 and 2014 was selected using population and

health linked databases. HZ and diabetes were defined using ICD-9

codes. We compared incidence of HZ, and health care resource

consumption due to HZ in a 6 months period after HZ between

diabetic and non-diabetic population. We performed different

statistical generalized linear models to compare diabetic and non-

diabetic populations.


The cohort consisted of 2,289,485 subjects

50 years old,

including 386,821 diabetics. HZ incidence rate was 935.52 cases/

100,000 diabetic population

year. The risk of HZ increased in

diabetics with respect to no-diabetics (RR 1.24, 95% credibility interval

[CrI] 1.22

1.26). Diabetics had 4% higher risk of attending to an

outpatient visit due to HZ than non-diabetic (RR 1.04, 95% confidence

interval [CI]: 1.02

1.05), they were more likely to be hospitalized

(OR 1.65, 95% CI: 1.40

1.93), had higher risk of receiving medication

(RR 1.20, 95% CI: 1.16

1.24) and they had longer periods off work (Days

off work means ratio: 1.44, 95% CI: 1.09

1.92). 24% of well controlled

diabetics (A1C levels

6.5) worsen after HZ.


Diabetes increased by 24% the risk of HZ. HZ contributed

to a diabetes decompensation and higher health care resource

consumption than non-diabetics.


HIV in elder people

a forgotten disease

L. Pedro


, E. Campôa


, T.M. Gaspar


, F. Azevedo


, R. Pinho


, J. Gallardo



J.M. Ferreira


, D. Faria


, C. Santos


, L. Arez




Algarve Hospital Center,

Portimão Hospital Unit, Department of Medicine 4, Portimão,



Hospital Center, Faro Hospital Unit, Department of Medicine 3, Faro,



Human immunodeficiency virus (HIV) is commonly

associated to younger individuals, being forgotten when the patient

has reached 65

80 years old or after the eighties (>80). Nevertheless,

as HIV associated death rate increases with age, is important to screen

and test people older than 65 years old.

Clinical case:

An 89 year-old woman, autonomous, with a clinical

history of high blood pressure, medicated with 3 types of anti-

hypertensives was diagnosed HIV-1 due to possible post-transfusion

infection with a nadir CD4 of 647 cell/μL (stage 1). The patient was

medicated with 300 mg Abacavir, 150 mg Lamivudine and 300 mg

Zidovudine along with immunologic and virologic response. Admitted

in the ER for dyspnea and confusion; on clinical examination with

polypnea, decreased breath sounds and scattered hissing. After the

thorax x-ray a community-acquired bilateral pneumonia was propose

for diagnosis and antibacterial therapy with ceftriaxone was initiated.

However, although an analytical improvement and an apparent

response to the treatment, the patient developed a progressive

respiratory and haematological failure, ending with the death in the

24th day after hospital admittance.


In this case, although the sustained virologic suppression

and an apparent immune response, the inherent age immunologic

alterations with the HIV infection, even in a less severe stage, elevates

the tendency to infectionwith a high morbidity and mortality rate. It is

crucial, in HIV carrying patients, the medical team always consider the

associated and avoidable complications of the immunosuppressed



Clinical and economic burden of pneumococcal disease in older

adults with chronic conditions in the United States

H.K. Yang, D. Zhang, P. Mavros, T. Petigara.

Merck & Co., Inc., Kenilworth,

New Jersey, USA

Background and aims:

Older adults with chronic conditions are at

high risk for pneumococcal infection. Limited studies have examined

both the clinical and economic burden of pneumococcal disease in

this population. We assessed pneumococcal disease rates, resource

utilization and costs in US adults 65+ years with chronic conditions

indicated for pneumococcal vaccination by ACIP.


A retrospective cohort study using medical and pharmacy

claims fromHumana health plans was conducted to compare rates and

cost of all-cause pneumonia, pneumococcal pneumonia and invasive

pneumococcal disease (IPD) in immunocompetent older adults 65 + y

with and without chronic conditions. Conditions of interest were

diabetes, chronic heart, liver and lung disease, and asthma.


Among 4.3 million older adults included in the analysis, 34.0%

had no condition; 31.3% had diabetes, 28.8% chronic heart disease,

17.5% chronic lung disease, 5.4% asthma and 2.9% chronic liver disease.

Older adults with chronic conditions had 3 times the rate of all-cause,

pneumococcal pneumonia, and IPD compared to healthy older adults.

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