Direct Mail to Older Adults at Risk for Pneumococcal Disease Improves Vaccination Rates

A targeted mailing campaign substantially increased pneumococcal vaccination (PV) rates among high-risk adults aged 65 and older, according to a study published in Archives of Cardiovascular Diseases. Researchers in France found a 9.5 percentage point increase in PV coverage within the intervention group, compared to only a 1.9 percentage point rise in a control group matched for multiple variables.¹

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Although clinical guidelines recommend PV for older adults at increased risk for serious complications from the infection and the vaccination is fully reimbursed in France, uptake remains low, the authors wrote.¹

The study, conducted in the Loire-Vendée-Océan Territorial Health Community in France, involved 7,472 patients aged 65 and older with diabetes, chronic heart disease, or respiratory diseases, who had not received a PV in the previous 2 years. Participants were compared to a "usual care" control group of 25,897 individuals with similar clinical characteristics.

The intervention centered on a direct mail campaign in 2022 that encouraged participants to discuss PV immunization with their general practitioners (GPs). GPs were also informed about the campaign. Investigators assessed PV coverage 6 months following the intervention.¹

PV vaccine coverage, defined as "the delivery of at least one dose of PV per patient" improved significantly within the intervention group, rising from 13.8% to 23.3%, compared to a more modest increase from 16.3% to 18.2% in the control group (P <.001). Notably, subgroups of patients with chronic heart disease and diabetes, who exhibited lower baseline PV coverage, experienced the most significant benefits from the intervention, according to the results.

Researchers concluded that targeted mailing campaigns are a "feasible and effective intervention to improve vaccine coverage" among eligible patients. The success of this pilot study has led to plans for a larger-scale regional program to further implement and evaluate this intervention.¹

Pneumococcal infections remain a significant public health concern, contributing to substantial morbidity and mortality, particularly among older adults and individuals with chronic conditions. In the United States, coverage with at least 1 dose of any type of pneumococcal vaccine among adults aged 65 and older was 64% in 2022, and rates were similar the year before, according to the CDC.² Pneumococcal pneumonia leads to as many as 225,000 hospitalizations in the US annually, according to the National Foundation for Infectious Diseases, and up to 7% of those infections are fatal.³

References
1. Stévant D, Seurin T, Perrot J, et al. Feasibility and efficacy of a targeted mailing campaign to improve pneumococcal vaccine coverage: a local pilot study. Arch Cardiovasc Dis. 2025;118(1):S131. https://doi.org/10.1016/j.acvd.2024.10.248
2. Vaccination coverage among adults in the United States, National Healthy Interview Survey, 2022. CDC. October 4, 2024. Accessed April 1, 2025. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccination-coverage-2022.html
3. Pneumococcal disease. National Foundation for Infectious Diseases. Updated October 2024. Accessed April 1, 2025. https://www.nfid.org/infectious-disease/pneumococcal/