Adult Pneumococcal Vaccine: Who Needs It? When and Why?
The rules for pneumococcal vaccination can seem a little arbitrary. See what you know about the ACIP rationale behind these 5 recommendations for PCV13 and PPSV23.
Who needs the pneumococcal vaccine and when and why do they need it?
Q1. Prevnar (PCV13) is recommended to be given to persons age >65 yrs with Pneumovax (PPSV23) to be given 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. As noted, 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. PPSV23 is recommended for smokers aged ≥19 yrs. Why is it not recommended for an 18-year-old who smokes?
Answer: A. No data exist showing an increased risk for pneumococcal disease for those aged <19 yrs who smoke.
Q4. Do adults aged >18 yrs who use smokeless tobacco (chewing tobacco) daily need PPSV23?
Answer: D. No, users of smokeless tobacco are not at significant increased risk for pneumococcal disease, according to ACIP.
Q5. 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. What do you tell her about receiving PPSV23?
Answer: A. She needs a PPSV23 and it can be given today.
Resources
Immunization Action Coalition. Ask the Experts/ Pneumococcal Vaccines (PCV13 and PPSV23). Accessed 8-19-19 and available at: http://www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp#pcv13_adults
CDC. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2012;61:805-822.
The rules for pneumococcal vaccine administration are well known to all healthcare providers but some of those rules can seem a little arbitrary. The Advisory Committee on Immunization Practices (ACIP) does have rationale for all its guidelines. See if you are familiar with the rationale behind these 5 recommendations.
