Technically Speaking: Remember to Routinely Administer TWO Pneumococcal Vaccines One Year Apart to Healthy Adults Age 65 and Older

In Sept. 2014, the Centers for Disease Control and Prevention (CDC) released recommendations for the use of two pneumococcal vaccines for routine vaccination of healthy adults age 65 years and older. The recommendations currently state:

• Administer one dose of pneumococcal conjugate vaccine (PCV13, Prevnar13®, Pfizer) to people age 65 years and older if they have not received a dose in the past.
• Administer one dose of pneumococcal polysaccharide vaccine (PPSV23, Pneumovax®, Merck) one year following the PCV13 dose. If your patient received PCV13 at an age younger than 65, administer PPSV23 at age 65 years (at least one year after PCV13).
• If your patient already received a dose of PPSV23 at age 65 or older, they don’t need another dose.

Where we’ve been and where we are now

Beginning in 1984, the Advisory Committee on Immunization Practices (ACIP) recommended the use of PPSV23 universally for all adults age 65 and older. This vaccination has been part of the official U.S. adult immunization guidance for more than 30 years.

In Sept. 2014, the second pneumococcal vaccine, PCV13, was added to the routine immunization schedule for healthy adults age 65 years and older.

When the recommendations to give these two pneumococcal vaccines to adults were first issued, the doses of PCV13 and PPSV23 were to be spaced at least six months apart. In Sept. 2015, ACIP changed the recommended interval between the two doses, extending it to one year for healthy adults.

Both pneumococcal vaccines are fully covered under Medicare

Like influenza vaccine, both doses of pneumococcal vaccine for people 65 years and older are covered at 100 percent under Medicare Part B. There is no out-of-pocket expense for people on Medicare. The doses must be administered one year apart (and should not be given at the same visit).

Vaccinating people younger than age 65

CDC has published recommendations for the use of both PCV13 and PPSV23 in people younger than age 65 who have certain high-risk conditions. Consult the ACIP recommendations for details.

Tips for vaccinating people age 65 and older

1. Use every office visit as an opportunity to assess your patient’s immunization needs and to vaccinate (or refer).
2. During an influenza vaccination visit, remember to also administer PCV13 if your patient needs it.
3. During the next year’s influenza vaccination visit, remember to administer PPSV23 at that same visit, if your patient needs it (if it’s been at least one year since receipt of the PCV13 dose).
4. If your patient doesn’t know (and can’t find out) if they received PCV13 or PPSV23 in the past, administer PCV13 now. One year later, administer PPSV23. Document the doses and give your patient a hand-held record card.
5. If you have an adult immunization registry in your state or region, enter the doses into it.
6. Make sure that your patient has also received all other routinely recommended vaccines, including zoster (shingles) and Tdap.
7. If you don’t administer some or all adult vaccines in your practice, refer your patient to a pharmacy or other community vaccination setting. This way you help them stay up to date with their recommended vaccines.

Pneumococcal vaccine resources from IAC

• Ask the Experts Q&A from CDC Experts – Pneumococcal Vaccines
• Pneumococcal Vaccines: CDC Answers Your Questions
• Standing Orders for Administering Pneumococcal Vaccines to Adults
• Protect yourself from pneumococcal disease...Get vaccinated!