March, 2020: New Recommendations for Pneumococcal Vaccines

Written by: Candi Henderson, CPhT, LPhT and Michelle Carey, CPhT, LPhT

Key Points

  • Two pneumococcal vaccines, PCV13 and PPSV23, are currently used in the United States.
  • Previously, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults 65 years and older should receive the PCV13 vaccine and then at least one year later receive the PPSV23 vaccine.
  • PCV7 was introduced into the pediatric immunization schedule in 2000 and was then replaced by PCV13 in 2010. This change led to a significant decline in pneumococcal disease among both children and adults.
  • Based on a review of evidence, the ACIP has changed the recommendation for PCV13 use in adults.

History

Pneumococcal disease may present in the form of serious diseases such as pneumonia, bacteremia, and meningitis. Those at higher risks for this disease include individuals with certain medical conditions, advanced age, and those with frequent exposure to others with the disease.

There are two vaccines to help prevent pneumococcal disease in the United States. This includes PCV13 and PPSV23. Previously, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults 65 years and older should receive the PCV13 vaccine at least one year prior to receiving the PPSV23 vaccine. In 2000, the PCV7 vaccine was introduced into the pediatric immunization schedule and was then replaced by the PCV13 vaccine. Adding the PCV13 vaccine to the pediatric immunization schedule has led to significant declines in pneumococcal disease among both children and adults.1

From 2014 through 2018, new studies were conducted to evaluate the safety and benefits of the pneumococcal vaccine recommendations. In 2016, the ACIP Pneumococcal Vaccines Work Group began to review evidence regarding the clinical and economic benefits and harms of PCV13 use among adults aged 65 years and older.1 Based on a review of accrued evidence, the ACIP has now changed the recommendation for PCV13 use in adults.

Current Recommendations

PCV13 vaccination is no longer routinely recommended for all adults age 65 years and older. Those with no compelling indications should only receive a single dose of PPSV23 at 65 years and older.1

Those with certain medical conditions including diabetes, chronic heart, lung, or liver disease, and persons who smoke cigarettes are recommended to receive a single dose of PPSV23 at age 19-64 and then again at 65 years and older. There should be at least 5 years between these two doses.

Those who are immunocompromised and have certain medical conditions (sickle cell disease, chronic renal failure, HIV, malignancies, etc.) at age 19-64 years should receive PCV13, then 8 weeks later PPSV23, then 5 years later an additional dose of PPSV23. At 65 years and older, these individuals should receive PCV13 only if they haven’t received it previously and then 8 weeks later a single dose of PPSV23 (if PPSV23 was previously received, wait at least 5 years from the previous dose).1

Considerations for Those at a Higher Risk

Consideration for deciding to use PCV13 for a particular person may include both the risk of exposure to the disease and the risk for developing pneumococcal disease as a result of underlying medical conditions such as immunocompromising conditions, CSF leak, or cochlear implant.

Adults age 65 and older who are at an increased risk for exposure to PCV13 serotypes might attain higher than average benefit from PCV13 vaccinations. This includes:

  • Persons residing in nursing homes or other long-term care facilities
  • Persons residing in settings with low pediatric PCV13 uptake
  • Persons traveling to settings with no pediatric PCV13 program
  • Persons with diabetes, alcoholism, or chronic heart, lung, or liver disease
  • Persons who smoke cigarettes
  • Persons who have multiple chronic medical conditions1

Providers caring for high risk patients may consider offering PCV13 to those 65 years and older if it is clinically determined to be appropriate. If the decision to administer PCV13 is made, PCV13 should be administered at least one year prior to administering PPVS23.1

References

  1. Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2019;68:1069–1075.

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