The Centers for Disease Control and Prevention (CDC) released new pneumococcal vaccine recommendations for adults age 65 years and older in the September 19 issue of Morbidity and Mortality Weekly Report. These recommendations involve administering in series BOTH pneumococcal conjugate vaccine (PCV13, Prevnar 13®, Pfizer) and pneumococcal polysaccharide vaccine (PPSV23, Pneumovax®23, Merck) to patients beginning at age 65 years. The two pneumococcal vaccines are not to be administered at the same office visit, and PCV13 should only be given to patients age 65 and older who have not received a previous dose of PCV13. Some details follow:
New pneumococcal vaccine recommendations for adults age ≥ 65 years
- Patient history: No previous pneumococcal vaccine (of either type or at any age) or pneumococcal vaccination history unknown
Give: PCV13 at age 65 (or older) followed by PPSV23 6–12 months later.
- Patient history: Previous dose of PPSV23 vaccine received at age 65 or older
Give: PCV13 at least one year after the PPSV23 dose.
- Patient History: Previous dose of PPSV23 vaccine received before age 65
Give: PCV13 at age 65 (or older), at least one year after the most recent PPSV23 dose. Give the final dose of PPSV23 6–12 months after PCV13, and at least five years after previous PPSV23 dose.
In addition to the new recommendations for adults age ≥ 65 years, PCV13 and/or PPSV23 continue to be recommended for high-risk adults age 19 years and older with certain health conditions (e.g., immunosuppression, asplenia, heart disease, lung disease, sickle cell disease, diabetes, alcoholism, and cirrhosis) and lifestyles (e.g., cigarette smoking). The prior vaccine history of these individuals increases the complexity of applying the new pneumococcal vaccine recommendations when they reach age 65 years. Detailed information covering the recommendations for these persons may be accessed through the links shown below.
Every year in the United States, thousands of adults die and many more are hospitalized from pneumococcal disease. Be sure your patients are appropriately immunized by assessing their immunization status for all recommended vaccines – including pneumococcal – during every healthcare visit. Of course, an especially opportune time for this assessment is when they receive influenza vaccine in the fall. According to CDC, either type of pneumococcal vaccine may be administered at the same time as influenza vaccine.
CDC pneumococcal vaccine recommendations
For adults ≥ 65 years of age
Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (pages 822–5)
For adults 19 through 64 years of age with certain health conditions or lifestyles
Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (pages 816–9)
Additional pneumococcal vaccine information from CDC
Pneumococcal vaccine information from IAC