November 2023: Case Studies

CASE 1

NT is a 39-year-old man who is scheduled to get his COVID-19 booster the next day, but he has had an upper respiratory tract infection during the past week. His primary care provider prescribed NT medications for congestion and cough. NT does not have arthralgia or a fever. He asks whether he is still eligible to receive his booster dose the next day or should reschedule.

What should the pharmacist tell him?

A mild acute illness, such as diarrhea or a mild upper respiratory tract infection, with or without fever, is not a precaution for vaccine administration, whereas a moderate to severe illness is. The concern in vaccinating an individual with moderate or severe illness is that a fever following the vaccine could cause complications. For example, it could be difficult to determine whether the fever resulted from the acute illness or the vaccine. The pharmacist should determine the severity of NT’s illness to determine whether deferring the booster could increase his risk of getting COVID-19. If his symptoms are mild and/or he is at risk for getting COVID-19, he should receive his booster as scheduled. If not, NT can defer his booster dose until the upper respiratory tract symptoms improve.

CASE 2

MN, a 67-year-old woman, is requesting a pneumonia vaccine at the advice of her primary care provider. She is being treated for hypertension, hypothyroidism, occasional heartburn, and osteoporosis. MN does not smoke and has no known drug allergies. She recalls getting influenza and shingles vaccines prior to recently moving from a different state, but she does not remember whether she has ever had a pneumonia vaccine. The pharmacy has Pneumovax 23 (PPSV23), Prevnar 13 (PCV13), and Prevnar 20 (PCV20) in stock.

Which is the most appropriate to administer to MN right now?

Adults 65 years or older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV15 or PCV20), according to the Advisory Committee on Immunization Practices. If PCV15 is used, it should be followed by a dose of PPSV23. Based on the in-stock options, the pharmacist should administer the PCV20 vaccine to MN. A single dose (0.5 mL) should be administered intramuscularly.

About the Author

Stefanie C. Nigro, PharmD, BCACP, CDCES, is an associate clinical professor in the Department of Pharmacy Practice at the University of Connecticut School of Pharmacy in Storrs.

References

1: Ask the experts: administering vaccines. Immunize.org[KK1] . Updated August 15, 2021. Accessed January 7, 2022. https://www.immunize.org/askexperts/administering-vaccines.asp

2: Advisory Committee on Immunization Practices votes to recommend routine use of Pfizer’s Prevnar 20 (pneumococcal 20-valent conjugate vaccine) in adults. News release. Pfizer. October 20, 2021. Accessed January 21, 2021. https://www.businesswire.com/news/home/20211020006069/en/Advisory-Committee-on-Immunization-Practices-Votes-to-Recommend-Routine-Use-of-Pfizer%E2%80%99s-PREVNAR-20%E2%84%A2-Pneumococcal-20-valent-Conjugate-Vaccine-in-Adults