August 4, 2016

Pneumococcal Vaccination Schedule for the Elderly

Arkansas Geriatric Education Collaborative

Arkansas Geriatric Education Collaborative

By Jeremy Hanner (PharmD Student and Lisa C Hutchison, PharmD, MPH

The pneumococcal vaccines protect against serotypes of the bacteria, Streptococcus pneumoniae, whose infections can lead to pneumonia, sepsis, and meningitis. The Centers for Disease Control (CDC) estimate that 900,000 Americans contract pneumococcal pneumonia each year, resulting in as many as 400,000 hospitalizations annually. Additionally, there are around 3,700 deaths attributable to pneumococcal sepsis and meningitis each year. The CDC has recently set guidelines stating individuals over the age of 65 should be immunized with the series of 2 vaccines: conjugated vaccines (Prevnar 13, PCV 13), and polysaccharide vaccines (Pneumovax 23, PPSV 23) [1]. Unfortunately, many of our senior citizens never had the pneumococcal series started, or had it only one component completed. This article reviews where to begin and how to continue when evaluating patients who have not received either pneumococcal vaccine, and those who have received either PPSV 23 or PCV 13 but not both.

When assessing adults 65 years and older for pneumococcal vaccination, first one must determine their vaccination history. If a patient has never been vaccinated, he/she should receive one dose of PCV 13 followed by one dose of PPSV 23, separated by at least one year. Those with certain risk factors (i.e., compromised immune system, CSF leaks, asplenia, or cochlear implant) can receive the doses 8 weeks apart [2].

The next situation to consider is an elderly patient who has received one pneumococcal vaccine, but not the other. If a single dose of PPSV 23 was given after age 65, it is recommended that these patients receive one dose of PCV 13, at least one year after the PPSV 23 vaccination was given. Exactly opposite, if a single dose of PCV 13 was given after age 65, it is recommended that the patient receive one dose of PPSV 23, at least one year after the PCV 13 was given [2]. Both vaccines are needed for better coverage, and it is preferred that PCV 13 is administered first in sequence when possible [3].

The final population to consider is those who have completed the pneumococcal series earlier in life and need to be vaccinated again. Younger patients at high risk for pneumococcal disease usually receive PCV 13, followed by PPSV 23, with another PPSV 23 booster five years later. So if a patient has received both vaccines before the age of 65; it is recommended that they receive one final dose of PPSV 23 at or after age 65. This final dose must also be at least 5 years apart from the previous PPSV 23 dose [1, 2].

The three types of patient populations above represent the most common pneumococcal immunization scenarios. More complicated patients may present requiring referral back to the vaccine recommendation guidelines. Either way, proper administration of pneumococcal vaccines is useful to reduce morbidity and mortality in the elderly population.

References:
1. “Fast Facts.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2015.

2. Miwako Kobayashi, MD1,2; Nancy M Bennett, MD3,4; Ryan Gierke, MPH1; Olivia Almendares, MSPH1; Matthew R Moore, MD1; Cynthia G. Whitney, MD1; Tamara Pilishvili, MPH1 , “Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. September 4. 2015 / 64(34); 944-947.

3. Immunization Action Coalition. “Ask the Experts: Diseases & Vaccines.” Ask the Experts: Pneumococcal Vaccines (PCV13 and PPSV23). Saint Paul Minnesota.
http://www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp