Updated 2015 ACIP recommendations on Pneumococcal Vaccination in Adults.

Immuno compromised patients are at a higher risk of developing invasive pneumo coccal disease, so are the adults of 65 years or above.

Pneumococcal diseases: are caused by a bacteria named Streptococcus pneumoniae, capable of causing pneumonia, sepsis, vision & hearing loss, meningitis & death.

Advisory Committee on Immunization Practices (ACIP) of the Centre for Disease Control and Prevention (CDC) has changed one guideline in adult’s immunization schedule in comparison to the last year’s. Now the adults of age 65 or above need to get shots of 13-valent pneumococcal  conjugate vaccine (PCV13) in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23).

Annals of Internal Medicine February included the latest modified guidelines by the APIC on the Immunization Schedule for adults of 19 years and older. These recommendations have been made official after the consent and approval from CDC’s ACIP, The American Congress of Obstetricians and Gynecologists (ACOG), American College of Nurse- Midwives (ACNM), American College of Physicians (ACP), and American Academy of Family Physicians (AAFP).

Studies: 2 randomized, multi centre immunogenecity studies conducted in US & Europe among older adults revealed the immune response produced by PCV13 to be identical to that of PPSV23.

PCV13: works against the S.pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F & 23F.

PCV13 & PPSV23 vaccination rules: 

  • When required, only a single dose of PCV13 can prove effective in adults.
  • At or after the age of 65 years when once vaccinated by PPSV23, no extra doses of PPSV23 are needed.
  • If both the vaccines, PCV13 & PPSV23 are indicated, PCV13 should be initiated or given first in the adults and PPSV23 should not be administered in the same visit.
  • If a patient has an incomplete or missing history on his or her pneumococcal vaccination data/profile, then if indicated, PCV13 & PPSV23 should be administered in such adult.

Adults aged 65 years or older who:

  • have never received PCV13 or PPSV23, should be given PCV13 and after a 6-12 months gap PPSV23 administration is recommended.
  • have received PCV13 but not PPSV23 before 65 years of age… should be administered with PPSV23 6-12 months after PCV13 vaccine or as soon as possible if this time span has passed.
  • have been vaccinated with PCV13 and one or more times with PPSV23 before reaching 65 years have to be inoculated with PPSV23 6-12 months after PCV13 vaccination or as soon as possible if this time window has passed and 5 years after the most recent dosing of PPSV23.
  • have been administered with a dose of PPSV23 at 65 years of age or older but have never been vaccinated with PCV13… needs to be given PCV13 at least 1 year after the dose of PPSV23 received at 65 years or older.
  • have not been administered with any dose of PCV13 vaccine but have been administered with one or more dose of PPSV23 vaccine before the age of 65 years, needs to get immunized with PCV13 at least one year after the most recent dose of PPSV23. The best option recommended is the administration of one dose of PPSV23 6 – 12 months after PCV13 administration or if this time window has passed then the immunization should be done as soon as possible & should be continued for at least 5 years after the most recent dose of PPSV23.

Adults of age 19 through 64 years with immuno compromised states or functional or anatomical asplenia (absence or defective functioning of spleen) who:

  • have not been vaccinated with PCV13 or PPSV23 should be given PCV13 followed by PPSV23, separated by at least time span of 8 weeks after PCV13 inoculation. After 5 years of a first dose of PPSV23, a second dose of PPSV23 should be administered.
  • have not been administered with PCV13 but have been given two doses of PPSV23, the PCV13 vaccine should be given after one year of last dose of PPSV23.
  • have been administered with PCV13 and one dose of PPSV23 needs after 5 years of administration of first dose of PPSV23 to be vaccinated with the second PPSV23 dose.
  • have not been administered with PCV13 but one dose of PPSV23 have been given in the same adult should be inoculated with PCV13 vaccine after one year of PPSV23 vaccination.
  • PCV13 have been given but not PPSV23, such adult should be given PPSV23 after the 8 weeks interval of PCV13 vaccination. The second dose of PPSV23 can be administered after giving a space of at least 5 years after its first dosing.
  • Adults 19-64 years who smoke or live in nursing homes or are on a long term care facilities require PPSV23 vaccination.
  • Adults 19-64 years having CSF leaks or gone through a cochlear implantation should be administered with PPSV23 8 weeks after administering PCV13 vaccine.
  • Adults 19-64 years with chronic heart diseases, chronic liver or chronic lung diseases, alcoholism or Diabetes mellitus need PPSV23 vaccination.

This schedule is formulated in accordance to the patient’s age, medical & clinical conditions & whether he or she has been immunized with PCV13 or PPSV23.

Problems with co-administration of these two vaccines: when used simultaneously, PPSV23 cancels the action of or makes PCV13 non responsive.

PCV13 not suitable in: who are allergic to or has shown a hypersensitivity reaction to this vaccine or to an earlier pneumococcal PCV7 vaccine or to any vaccine containing Diphtheria toxoid (conjugation with non toxic diphtheria protein).

PCV13 side effects in adults: pain, swelling, redness at the site of injection. Fatigue, fever (mild), headache, decreased appetite have been seen to be associated with this agent.

According to the authors, by ensuring that the patients are receiving their properly timed pneumococcal vaccinations, the health care providers can play a vital role in reducing the number of deaths in adults induced by pneumococcus.

 Reference:

  • Centre for Disease Control and Prevention’s  Advisory Committee on Immunization Practices 2015.
  • Medscape February 2015.
  • Annals of Internal Medicine 2015.
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