UPDATE ON PNEUMOCOCCAL VACCINES

CSF showing meningitis caused by S. pneumoniae Photo Credit: Content Providers(s): CDC/Dr. M.S. Mitchell - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #1003

Objectives for Today• Describe pneumococcal disease basics• Identify which adults need both PCV13 and PPSV23• Indentify which adults age 19-64 need just PPSV23

Pneumococcal Disease• Second most common cause of vaccine preventable

death in the US• Major clinical syndromes include

• Pneumonia• Bacteremia• Meningitis

.

It is better to prevent than to try and fight pneumococcal disease with antibiotics that might not work.

Pneumococcal Pneumonia • Estimated 175,000 hospitalizations in U.S.• Up to 36% of adult-community acquired pneumonia and

50% of hospital acquired pneumonia• Common complication (bacterial) of influenza and

measles• Case fatality rate 5-7%, much higher in elderly

Pneumonia of the right middle lobe

Pneumococcal Bacteremia• More than 50,000 cases per year in the United States• Rates higher among elderly and very young infants• Case-fatality rate ~20%; up to 60% among the elderly

Septi Chek Blood Culture Bottles

Pneumococcal Meningitis• Estimated 3,000–6,000 cases per year in the United

States• Case-fatality rate ~30%, up to 80% in the elderly• Neurologic sequelae common among survivors• Increased risk in persons with cochlear implant

Photo courtesy of CDC

The following are at HIGH RISK for PNEUMOCCAL DISEASE:

●Those ≥ 65 Years of Age●Persons 19-64 years with asthma or smokes cigarettes●Persons 19-64 with chronic illnesses

Adult 65 and Older• CDC recommends all adult ≥ 65 receive 2 types of

pneumococcal vaccines• One dose of PCV13 (first)• One dose of PPSV23 ( 6 to 12 months after PCV vaccine)• This age group requires both vaccines for the best protection

against pneumococcal disease

Adult 19 to 64 Years Who Only Need PPSV23

• Those with chronic conditions• Asthma• Diabetes• Heart disease• Alcoholism• Liver disease

• Cigarette smokers• Residents of nursing homes or other long-term care

facilities• When they turn 65 this group should receive a dose of

PCV13

Adults 19 to 64 Who Should Receive both PCV13 and PPSV23*• Functional or anatomic asplenia†• Cochlear implants • Cerebrospinal fluid leaks†• Lymphoma, leukemia, Hodgkin disease,†• Solid organ transplants†

• * PCV13 and PPSV23 cannot be given at the same visit• † A second PPSV23 vaccine is recommended for these

individuals five years after the first PPSV23 dose

Age 65 Years or Older

Age 19-64 Years with Underlying Conditions

The Centers for Medicare and Medicaid Services Update• CMS is updating their coverage to align with the new

ACIP Pneumococcal Vaccine guidelines• An initial pneumococcal vaccine to who have never received the

vaccine under Part B; and• A different, second pneumococcal vaccine one year after the first

vaccines was administered

Effective dates of service on or after September 19, 2014 and does not require that a doctor of medicine or osteopathy order the vaccines.

Scenario 1• 66 year old patient with a cochlear implant. Previously

received a PPSV23 at age 55. What pneumococcal vaccine (s) does this patient need?

Scenario 2• A 20 year old asthma patient shows at your clinic, asking

for a shot of that” new pneumonia shot” (PCV13). Does this patient need a PCV13 or a PPSV23 today?