The Advisory Committee on Immunization Practices (ACIP) in November 2019 again updated its recommendations for pneumococcal vaccination among adults aged ≥65 years.
The update amends the ACIP’s 2014 statement that recommended routine use of the pneumococcal conjugate vaccine (PCV13) in series with pneumococcal polysaccharide vaccine (PPSV23) for all adults in this age range. For a brief review of the full history, click here.
To find out what you know-and might need to know-about administration this year, try the 5 questions that follow.
Q1. After shared decision making with a patient aged >65 yrs leads to the plan to administer Prevnar 13, then Prevnar should be given first, followed by Pneumovax (PPSV23) at least a year later. Why is the 13-valent vaccine given first when the 23-valent vaccine covers an extra 10 strains of pneumococcus?
Answer: A. Antibody levels are higher after the 2nd vaccination when they are given in this order.
Q2. For healthy persons aged ≥65 yrs, the second dose of pneumococcal vaccine should be given 1 year after the first. What happens if you give Prevnar on October 21 and Pneumovax on October 1st the following year?
Answer: C. From a medical perspective, the antibody response will not be significantly different, and Medicare will pay for it.
Q3. Prevnar is recommended for adults with certain conditions at any age. You have a 60-year-old woman in your office who has never received a pneumococcal vaccine. Which of these conditions would make you recommend a dose of Prevnar for her today?
Answer B. Sickle cell disease. A person with sickle cell disease is considered immunocompromised. While she most likely had received Pneumovax, if you can't confirm that, she should also receive that vaccine a year after the Prevnar dose.
Q4. You see a 25-year-old pregnant woman in her first trimester who smokes about 10 cigarettes a day.She has not received a PPSV23. Which one of the options above would you tell her?
Answer: A. She needs a PPSV23 and it can be given today. Pregnancy is not a contraindication to receipt of PPSV23.
Q5. A 60-year-old woman in your office has never received a pneumococcal vaccine. Which of the conditions above would make you recommend a Pneumovax injection today?
Answer: E. A and B. Homelessness is not an indication for Pneumovax, but alcoholism is, so A is correct.Chronic lung disease is an indication and would also include someone with COPD or emphysema, so B is correct.Chronic heart disease (eg, cardiomyopathy, CHF) is an indication, but isolated hypertension is not, so C would not be correct