Pneumonia Vaccination Recommendations
Prevnar 13 is now recommended for patients over the age of 50 who are immunocompromised and all patients over the age of 65.
It seems that every few years a new vaccine comes out on the market or there is a new recommendation for our patients. The newest? Prevnar 13. A large number of our patients have previously been vaccinated with pneumococcal polysaccharide vaccine (Pneumovax 23) and so the question becomes why another vaccine against the same organism?
To better understand this, it requires knowledge of both the vaccines. Both use polysaccharides that form the bacterial capsule to stimulate immunity. In the case of Pneumovax there are 23 strains that are vaccinated against and with Prevnar there are 13 strains. Some of these overlap. The 13 strains of Prevnar cover strains that cause 80 to 90 percent of all disease associated with the pneumococcal organism. The major difference is that Prevnar polysaccharides are "souped up" with proteins to stimulate another part of our immune systems. This increases the killing power and the memory of our immune systems. Therefore, if we are exposed we have a faster and more powerful immune response. Since this bacteria causes such severe and widespread disease in the elderly I agree and certainly recommend getting vaccinated with the Prevnar vaccine.
So, who should be vaccinated?
According to the CDC's Advisory Committee on Immunization Practices (ACIP), all patients between ages 50 and 65 who smoke, have lung disorders, who are on immunosuppressive therapy, who have had organ transplants, who take steroids on a regular basis, who have certain cancers or who have functional or anatomical aspleenia. Also, anyone over the age of 65 should be vaccinated according to the following recommendations:
Pneumococcal vaccine-naïve persons: Adults that are 65 years and holder who have not previously had a pneumococcal vaccine or whose vaccination history is unknown should receive a dose of PCV13 first and then a dose of PPSV23 6-12 months later. If PPSV23 cannot be given in this timeframe, the dose of PPSV23 should be given at the next office visit. Also, its important that the two vaccinations be given at different times and never together. The minimum acceptable interval between vaccinations is 8 weeks.
Previous vaccination with PPSV23: Adults 65 years or older who have previously received at least one dose of PPSV23 previously also should receive a dose of the PCV13 if they have not yet received it. A dose of PCV13 should be given up to one year after the most recent PPSV23 dose. This subsequent PPSV23 dose should be given 6–12 months after PCV13 and at least five years after the most recent dose of PPSV23.
Potential Time-Limited Utility of Routine PCV13: The recommendations for routine PCV13 use among adults 65 years and older will be reevaluated in 2018 and revised as needed.
The ACIP recommendations for the routine use of PCV13 in adults aged 19 years and older with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak or cochlear implants remain unchanged.
I have been told that the Prevnar vaccine is available to most Medicare patients at your local pharmacy at no cost. It is also covered by many commercial plans.
PL Detail-Document, Pneumococcal Vaccination in Adults: Who Gets What and
When? Pharmacist’s Letter/Prescriber’s Letter. November 2014.