Pneumococcal Vaccination Coverage Reached Only 23 Percent in Thai COPD Study

In a cross-sectional study conducted at a single tertiary care university hospital in Thailand, researchers found that only 23.2 percent of patients receiving regular follow-up for chronic obstructive pulmonary disease had received a pneumococcal vaccination. In stark contrast to the low coverage observed for pneumococcal disease, immunization rates were markedly higher for other recommended respiratory vaccines within the same patient cohort, reaching 89.9 percent for influenza and 91.3 percent for coronavirus disease 2019 (COVID-19).

Vaccination against influenza, COVID-19, and pneumococcal infection is clinically recommended for individuals diagnosed with chronic obstructive pulmonary disease to mitigate the risks of severe infections, pneumonia, and acute disease exacerbations. Despite these standing preventive recommendations, overall vaccination coverage in this clinical demographic has historically remained suboptimal. In response, the investigators sought to evaluate the precise proportions of patients receiving these preventive immunizations and to identify key demographic and clinical factors associated with vaccine uptake.

The study protocol was implemented in 2025 among patients managed in regular outpatient follow-up at the Thai tertiary center. A total of 377 patients with chronic obstructive pulmonary disease were screened for eligibility. Of these, 145 satisfied the formal inclusion criteria, and 138 patients provided informed consent and were included in the final statistical analysis. Male patients constituted the vast majority of the evaluated cohort, accounting for 84.8 percent of the 138 participants.

Data collection encompassed demographic profiles, underlying comorbidities, verified vaccination histories, and relevant clinical outcomes, including documented hospitalizations and acute exacerbations. The investigative team applied univariable logistic regression modeling to assess potential factors linked to each vaccination outcome. However, multivariable logistic regression modeling was conducted exclusively for pneumococcal vaccination, as the small number of patients unvaccinated against influenza and COVID-19 precluded robust multivariable modeling for those two conditions.

Statistical evaluation revealed distinct clinical patterns associated with pneumococcal immunization. In univariable logistic regression, a documented history of malignancy was significantly more frequent among participants who received the pneumococcal vaccine, demonstrating an odds ratio of 3.74 (95 percent confidence interval: 1.01 to 13.87; p = 0.048). In the subsequent multivariable analysis, both a body mass index greater than 23.5 kilograms per square meter and malignancy remained independently associated with pneumococcal vaccine uptake, showing adjusted odds ratios of 2.44 (95 percent confidence interval: 1.07 to 5.56; p = 0.035) and 4.10 (95 percent confidence interval: 1.07 to 15.80; p = 0.040), respectively.

For COVID-19 vaccination, univariable analyses indicated that specific cardiovascular comorbidities were less prevalent among vaccinated patients. Participants receiving COVID-19 immunization had lower odds of atherosclerotic cardiovascular disease, with an odds ratio of 0.31 (95 percent confidence interval: 0.09 to 1.04; p = 0.058). In addition, a diagnosed history of stroke or transient ischemic attack was significantly less common among vaccinated individuals, yielding an odds ratio of 0.21 (95 percent confidence interval: 0.06 to 0.80; p = 0.023).

Among participants who remained unvaccinated, the study identified primary self-reported obstacles to immunization. The most frequently cited reasons for non-vaccination included the perception that vaccines were unnecessary, an absence of explicit physician recommendation, and concerns regarding potential adverse effects. The authors concluded that pneumococcal coverage remains critically depressed despite high uptake for influenza and COVID-19, underscoring that patient knowledge gaps and insufficient clinician advocacy represent central barriers to optimizing protection in high-risk pulmonary populations.

The study, authored by Jidapa Jobumrung, Dararat Eksombatchai, and Sasisopin Kiertiburanakul and published in BMC Pulmonary Medicine, highlights critical opportunities for clinical improvement in managing chronic obstructive pulmonary disease. The authors stressed that closing the gap between high viral immunization coverage and low pneumococcal uptake requires directly addressing the identified barriers. Because the primary deterrents included knowledge gaps, absent physician recommendations, and adverse effect concerns, the researchers underscored that enhanced patient education programs and greater clinician engagement will be essential to improve vaccination coverage across this high-risk patient population.

In discussing the analytical scope, the researchers pointed out that the small number of participants who were unvaccinated against influenza and COVID-19 restricted the depth of statistical modeling for those infections. Consequently, while multivariable logistic regression successfully identified body mass index above 23.5 kilograms per square meter and malignancy as independent factors associated with pneumococcal vaccination, multivariable models could not be fitted for influenza or COVID-19, leaving observed associations with cardiovascular comorbidities unadjusted in multivariate analysis.

Subject of Research: Vaccination coverage and associated clinical factors among patients with chronic obstructive pulmonary disease in Thailand

Article Title: Factors associated with influenza, COVID-19, and pneumococcal vaccinations in patients with chronic obstructive pulmonary disease: a cross-sectional study in a Thai university hospital

Article References: Jobumrung, J., Eksombatchai, D., & Kiertiburanakul, S. (2026). Factors associated with influenza, COVID-19, and pneumococcal vaccinations in patients with chronic obstructive pulmonary disease: a cross-sectional study in a Thai university hospital. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04944-2

Image Credits: AI Generated

DOI: 10.1186/s12890-026-04944-2

Keywords: chronic obstructive pulmonary disease, COPD, pneumococcal vaccine, influenza vaccine, COVID-19 vaccine, vaccination coverage, vaccine uptake, cross-sectional study, Thailand, tertiary care hospital, malignancy, body mass index, atherosclerotic cardiovascular disease, stroke, transient ischemic attack, physician recommendation, acute exacerbations