New Pneumococcal Immunization Recommendations in Elderly Patients

Christopher Fuchs Pharm.D. Candidate 2015 Saint Louis College of Pharmacy

Christopher Fuchs
Pharm.D. Candidate 2015
Saint Louis College of Pharmacy

Pneumonia is the leading cause of infectious mortality in both children and adults. Pneumonia’s mortality ranges from 30% to 40%1, 2. With such a high mortality, one of the best options is to prevent the patient from ever getting pneumonia through immunization. As pharmacists, immunizing patients against pneumonia is a great opportunity for us to prevent a serious and life threatening infection.

Pneumonia is caused by several bacteria, viruses, and fungi. The most common bacterial pathogens include S. pneumoniae, M. pneumoniaeLegionella speciesC. pneumoniaeH. influenzae, P. aeruginosaAcinetobacter species, and methicillin-resistant Staphylococcus aureus (MRSA). S. pneumoniae is the most common pathogen and is the causative infection in 75% of pneumonia cases3. The influenza virus is the most common viral pathogen3.

There are currently two pneumonia vaccines on the market, 13-valent pneumococcal conjugate vaccine (PCV13, Brand name: Prevnar 13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23, Brand Name: Pneumovax23). PCV13 contains 13 serotypes of S. pneumoniae, specifically the 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F serotypes4. PPSV23 contains 23 serotypes of S. pneumoniae, specifically the 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F and 33F5. Both vaccines are easily accessible and have been proven to prevent pneumonia infections.

The Center for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) have recently updated their guidelines on the use of PCV13 and PPSV23 in patients > 65 years old. The update is a result of the outcomes in the Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA). The CAPiTA trial is a randomized, double-blind clinical trial with 84,496 participants’ age > 65 years old, which took place in the Netherlands. PCV13 was found to be 45.56% (p = <0.001) effective at preventing the first episode of vaccine-type community acquired pneumonia.

The old recommendations said to give PPSV23 to patients > 65 years old with no mention of PCV13. The new recommendations are broken down between vaccine-naïve patients and patients who have received PPSV23 already.

  • In vaccine-naïve patients > 65 years old: patients should receive one dose of PCV13 then a dose of PPSV23 six to twelve months later. The minimal time between pneumonia vaccines is 8 weeks6.
  • In patients previously vaccinated with PPSV23 > 65 years old: patients should receive one dose of PCV13 if they have not already received it. The dose of PCV13 should be given greater than or equal to one year since last PPSV23. If an additional dose of PPSV23 is indicated it should be six to twelve months from last PCV13 and greater than or equal to five years since last PPSV236.

These new recommendations will be in effect until 2018. In 2018, the ACIP will reevaluate the use of PCV13 in patients > 65 years old. The ACIP and CDC recommendations for other age groups and immunocompromised patients remain the same.

For more information about immunizations and current vaccine recommendations please take advantage of the MPA’s immunization webpage (available at https://www.morx.com/immunizations). On this page, MPA members can find information about immunization schedules, the latest immunization recommendations, specific information about the influenza vaccination, and information about National Immunization Awareness Month (NIAM).

Christopher Fuchs
Pharm.D. Candidate 2015
Saint Louis College of Pharmacy

References

  1. Nseir S, Mathieu D. Antibiotic treatment for severe community-acquired pneumonia: Beyond antimicrobial susceptibility. Crit Care Med 2012;40(8):2500–2502.
  2. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53(7): e25–e76.
  3. Blackford MG, Glover ML, Reed MD. Chapter 85. Lower Respiratory Tract Infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L.eds. Pharmacotherapy: A Pathophysiologic Approach, 9eNew York, NY: McGraw-Hill; 2014. http://accesspharmacy.mhmedical.com/content.aspx?bookid=689&Sectionid=45310531. Accessed November 17, 2014.
  4. Prenvar 13 Package Insert, Pifzer
  5. Pneumovac23 Package Insert, Merck
  6. Tomczyk S, Bennett NM, Stoecker C, et al. 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). MMWR Morb Mortal Wkly Rep. 2014;63(37):822-5.

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