Thursday, October 2, 2014

New pneumococcal recommendations

In August 2014, the Advisory Committee on Immunization Practices (ACIP) voted to recommend pneumococcal conjugate vaccine (PCV13, Prevnar-13®) for all adults 65 years or older. This dose is in addition to the existing recommendation of one dose of pneumococcal polysaccharide vaccine (PPSV23, Pneumovax®23).
  • PCV13 was licensed by the FDA (Food and Drug Administration) for use in adults 50 years or older in 2011.
  • Both PCV13 and PPSV23 should be routinely administered in series to all adults 65 years or older.
  • The two pneumococcal vaccines should not be administered at the same visit.
  • PCV13 should be given before PPSV23 because the optimal immune response is achieved when PCV13 is given first followed by PPSV23 for patients who have NEVER received PPSV23.
Both PCV13 and PPSV23 provide good protection against invasive forms of infection caused by vaccine-type pneumococci. 

For adults previously vaccinated with PPSV23:
  • Adults 65 years of age or older who have previously received one or more doses of PPSV23 should also receive a dose of PCV13 if they have not yet received it.
  • A dose of PCV13 should be given at least 1 year after the receipt of the most recent PPSV23 dose.
For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6 to 12 months after PCV13 and at least 5 years since the most recent dose of PPSV23.

 For pneumococcal vaccine-na├»ve adults: 
  • Adults 65 years of age or older who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed 6 to 12 months later by a dose of PPSV23.
  • If PPSV23 cannot be given during the 6 to 12 month time window, the dose of PPSV23 should be given during the next visit after 12 months. PPSV23 should not be given less than 8 weeks after the PCV13 dose.
Recommendations for routine use of PCV13 in adults at increased risk for pneumococcal disease remain unchanged: 
  • Adults 19 years of age or older with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later.
  • Adults at increased risk for pneumococcal disease who received PCV13 at 64 years or younger should not receive another dose of PCV13 at 65 years or older. 

If you have any questions, please call the Maine Immunization Program at 287-3746 or 1- 800-867-4775

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