Overcome Barriers to Increase Uptake of Pneumococcal Vaccines

Streptococcus Pneumoniae (Pneumococcus) is a lancet-shaped, gram-positive, facultative anaerobic bacterium and inhabits the respiratory tract in up to 90% of individuals. Because it is encapsulated with surfaces of complex polysaccharides, it tends to be pathogenic.

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Of the more than 100 known serotypes, only a handful cause most pneumococcal infections. Of most concern are infections that cause invasive pneumococcal disease (IPD), which is infection of normally sterile sites (Table 11) and community-acquired pneumonia (CAP).2 IPD and CAP are leading causes of morbidity and mortality in older adults with underlying medical conditions in the United States and contribute significantly to hospitalization rates.³

Pneumococcal disease is transmitted through coughing, sneezing, or contact with respiratory secretions or can be attributed to nasal carriage of S pneumoniae prior to invasive disease. In adults, symptoms that may signal pneumonia include sudden onset shaking or chills, fever, chest pain, dyspnea or rapid breathing, and a productive cough. In infants and young children, symptoms tend to be nonspecific and may include fever, cough, and rapid breathing.¹

Research indicates pneumococcal vaccines are highly effective in preventing hospitalization, infection, and death in older populations.^4-7 The Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination in healthy adults 65 years or older and individuals at higher risk of disease (eg, individuals with histories of smoking, homelessness, or substance use disorders).^8,9 Since June 2023, ACIP has also recommended the 20-valent pneumococcal conjugate vaccine (PCV) for routine use to help protect infants and children from IPD.¹⁰

THE VACCINES

Two types of pneumococcal vaccine are available in the United States. The pneumococcal polysaccharide vaccine (PPV) offers protection against 23 strains of S pneumoniae that account for approximately 90% of cases of pneumococcal disease.¹ Three PCVs (PCV13, PCV15, and PCV20) are available, with each type labeled with specific indications based on age and medical status. The PCVs are more immunogenic than PPV23, with PCV20 providing the broadest pneumococcal serotype coverage among currently available PCVs. However, PPV23 contains 3 serotypes that are not included in PCV20.^4,5

Because decisions about when to administer PCV vaccines and to whom can be complicated, the best source of information is either the CDC’s webpage on the topic or its online Child and Adolescent Immunization Schedule by Age.

Uptake of pneumococcal vaccines in adults is a global problem, even in high-income countries that offer routine and universal vaccination programs.⁸ Health care providers who administer these vaccines indicate that a large part of the problem is the recommendations, which are lengthy and complicated, and difficulty accessing patients’ vaccine records.⁹

Many nonpharmacy immunizers need to make decisions about what to recommend during short patient visits and more importantly what to stock, because these vaccines are costly and take up precious refrigerator space. Table 29 lists some talking points to use when consulting with providers about pneumococcal vaccines.

FILLING THE INFORMATION GAP

Because one complaint from health care providers is that immunization records can be difficult to find and patients are usually poor historians about vaccines, pharmacy staff can increase immunization rates by helping patients maintain their records.¹¹ Some states have established immunization information systems that include adult vaccines. Pharmacy staff can encourage parents to maintain their children’s vaccine records in a safe place, such as in baby books. Pharmacy staff can also remind adult patients to carry an adult immunization record with them; many are available for download online.

Patients may be able to determine their histories by checking with past employers, the military, their own medical records, and past or current health care providers. They should ask their health care providers to annotate such records with past and future immunizations. Having blank immunization records and distributing them to patients is a good way to encourage this practice. Immunize.org provides a handout to help patients find their records.¹¹

CONCLUSION

Good adherence to the CDC’s recommended vaccines in adulthood can prevent unnecessary hospitalizations and deaths. Healthy People 2030 is developing measures to track the number of adults who are up to date on vaccines and the number of individuals whose records are stored electronically.¹² Pharmacists and pharmacy technicians can help by asking simple questions such as, “Where do you keep your immunization records?” Lead by example and encourage others to track their immunizations.

About the Author

Jeannette Y. Wick, MBA, RPH, FASCP, is the director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

References

1. Pneumococcal conjugate 13-valent vaccine (Prevnar13) for adults with high risk medical conditions: Q&A for health care providers. Government of Ontario. December 2014. Accessed November 9, 2023. http://health.gov.on.ca/en/public/programs/immunization/docs/pcv_hcp_qa_en.pdf
2. Gierke R, Wodi P, Kobayashi M. Pneumococcal disease. CDC. Updated August 18, 2021. Accessed November 8, 2023. https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html
3. Drijkoningen JJC, Rohde GGU. Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect. 2014;20(suppl 5):45-51. doi:10.1111/1469-0691.12461
4. Ogilvie I, El Khoury A, Cui Y, Dasbach E, Grabenstein JD, Goetghebeur M. Cost-effectiveness of pneumococcal polysaccharide vaccination in adults: a systematic review of conclusions and assumptions. Vaccine. 2009;27(36):4891-4904. doi:10.1016/j.vaccine.2009.05.061
5. Moberley SA, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2013;2013(1):CD000422. doi:10.1002/14651858.CD000422.pub3
6. Johnstone J, Marrie TJ, Eurich DT, Majumdar SR. Effect of pneumococcal vaccination in hospitalized adults with community-acquired pneumonia. Arch Intern Med. 2007;167(18):1938-1943. doi:10.1001/archinte.167.18.19387.
7. Koivula I, Stén M, Leinonen M, Mäkelä PH. Clinical efficacy of pneumococcal vaccine in the elderly: a randomized, single-blind population-based trial. Am J Med. 1997;103(4):281-290. doi:10.1016/S0002-9343(97)00149-68
8. Kirubarajan A, Lynch M, Nasreen S, et al. Increasing pneumococcal vaccine uptake in older adults: a scoping review of interventions in high-income countries. BMC Geriatr. 2023;23(1):2. doi:10.1186/s12877-022-03653-9
9. Kahn R, Zielinski L, Gedlinske A, et al. Health care provider knowledge and attitudes regarding adult pneumococcal conjugate vaccine recommendations- United States, September 28-October 10, 2022. MMWR Morb Mortal Wkly Rep. 2023;72(36):979-984. doi:10.15585/mmwr.mm7236a2
10. ACIP updates: recommendations for use of 20-valent pneumococcal conjugate vaccine in children - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(39):1072. doi:10.15585/mmwr.mm7239a5
11. Tips for locating old immunization records. Immunize.org. Accessed November 5, 2023. https://immunize.org/wp-content/uploads/catg.d/p3065.pdf
12. Vaccination coverage among adults in the United States, National Health Interview Survey, 2019-2020. CDC. Updated February 17, 2022. Accessed November 5, 2023. https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/vaccination-coverage-adults-2019-2020.html