Technically Speaking |
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Monthly Column by Deborah Wexler, MD |
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IAC Executive Director Dr. Deborah Wexler writes
Technically Speaking, a column featured in each issue of
Vaccine Update for Healthcare Professionals,
the monthly e-newsletter from the Vaccine Education Center
(VEC) at the Children's Hospital of Philadelphia.
Technically Speaking columns cover practical topics in
immunization delivery such as vaccine administration
techniques, storage and handling, contraindications and
precautions, and scheduling. |
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Subscribe to VEC's
Vaccine Update for Healthcare Professionals to stay up to date
on vaccine-related issues, including reviews of recently
published journal articles, media recaps, and announcements
about new resources and webinars. To subscribe, visit the
Vaccine Update Newsletter Sign-up Form |
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The
archive of past Technically Speaking columns is also available through links on the right side of this web page. |
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TECHNICALLY SPEAKING |
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ACIP Updates Its Pneumococcal Vaccine Recommendations for Adults Age 65 Years and Older |
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Published
December 2019 |
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On November 22, CDC published
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
(ACIP) in Morbidity and Mortality Weekly Report (MMWR 68[46]:1069). This document updates ACIP's 2014 statement which recommended
routine use of pneumococcal conjugate vaccine (PCV13) in series
with pneumococcal
polysaccharide vaccine (PPSV23) for all adults in this age range.
Since that time, the incidence of PCV13-type disease has been
reduced to historically low levels
among adults age >65 through indirect effects from pediatric PCV13
use. Because of this changing epidemiology, ACIP has updated its recommendations on PCV13
vaccine scheduling in older adults and incorporated the concept of
shared clinical decision-making, as summarized below.
New Pneumococcal Vaccine Recommendations for Adults Age >65 Years
Old
- PCV13. PCV13 vaccination is no longer routinely recommended for
all adults age >65 years. Instead, shared clinical decision-making
for PCV13 use is
recommended for persons age >65 years who do not have an immunocompromising condition, CSF leak, or cochlear implant and who
have not previously received
PCV13.
- CDC guidance for shared clinical decision-making*. When patients
and vaccine providers engage in shared clinical decision-making for
PCV13 use to
determine whether PCV13 is right for the specific individual age
>65 years, considerations may include the individual patient's risk
for exposure to PCV13 serotypes
and the risk for pneumococcal disease for that person as a result
of underlying medical conditions.
*Considerations for shared clinical decision-making.
- PCV13 is a safe and effective vaccine for older adults. The risk
for PCV13-type disease among adults age >65 years is much lower
than it was before the
pediatric program was implemented, as a result of indirect PCV13
effects (by preventing carriage and, thereby, transmission of
PCV13-type strains). The remaining
risk is a function of each individual patient's risk for exposure
to PCV13 serotypes and the influence of underlying medical conditions on the patient's risk for developing
pneumococcal disease if exposure occurs.
- The following adults age >65 years are potentially at increased
risk for exposure to PCV13 serotypes and might attain higher than
average benefit from
PCV13 vaccination, and providers/practices caring for many patients
in these groups may consider regularly offering PCV13 to their
patients age >65 years who have
not previously received PCV13:
- 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
- Incidence of PCV13-type invasive pneumococcal disease and
pneumonia increases with increasing age and is higher among persons
with chronic heart,
lung, or liver disease, diabetes, or alcoholism, and those who
smoke cigarettes or who have more than one chronic medical condition. Although indirect effects from
pediatric PCV13 use were documented for these groups of adults and
were comparable to those observed among healthy adults, the
residual PCV13- type disease
burden remains higher in these groups. Providers/practices caring
for patients with these medical conditions may consider offering
PCV13 to such patients who are
age >65 years and who have not previously received PCV13.
- Scheduling when PCV13 is used. If a decision to administer PCV13
is made, it should be administered before PPSV23. The recommended
intervals between
pneumococcal vaccines remain unchanged for adults without an immunocompromising condition, CSF leak, or cochlear implant (>1
year between pneumococcal
vaccines, regardless of the order in which they were received).
PCV13 and PPSV23 should not be coadministered. (Note: ACIP
continues to recommend PCV13 in
series with PPSV23 for adults age >19 years [including those age
≥65 years] with immunocompromising conditions, CSF leaks, or
cochlear implants.)
- PPSV23 for all adults age >65 years. ACIP continues to recommend
that all adults age >65 years routinely receive 1 dose of PPSV23.
PPSV23 contains 12
serotypes in common with PCV13 and an additional 11 serotypes for
which there are no indirect effects from PCV13 use in children. The
additional 11 serotypes
account for 32%37% of invasive pneumococcal disease among adults
age >65 years. Adults age >65 years who received >1 dose of PPSV23
before age 65 years
should receive 1 additional dose of PPSV23 at age >65 years, at
least 5 years after the previous PPSV23 dose.
Access the full MMWR article to review the updated recommendations
in their entirety.
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This page was updated on
December 30, 2019. |
This page was reviewed on
December 30, 2019. |
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