Pneumococcal Vaccine Recommendations Updated

The CDC’s 2013 immunization schedules include several new recommendations regarding which patient groups should receive the various pneumococcal vaccines.

The Centers for Disease Control and Prevention (CDC) has published its 2013 immunization schedules based on recommendations from the Advisory Committee on Immunization Practices (ACIP). The schedules include several significant changes, including the recommendation that high-risk adults receive the 13-valent pneumococcal conjugate vaccine (PCV13).

ACIP recommends the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults older than 65 years and for those younger than 65 who are at high risk for pneumococcal disease or complications from pneumococcal disease. The FDA has approved PCV13 for all adults 50 years of age or older, but in this age group ACIP recommends the vaccine only for those at elevated risk for pneumococcal disease. In addition, ACIP recommends that at-risk patients receive both PCV13 and PPSV23. Immunizers should administer PCV13 first and follow up with PPSV23 approximately 2 months later. If a patient has received PPSV23 but not PCV13, immunizers should wait 12 months before administering PCV13.

The adult immunization guidelines for pneumococcal vaccination are somewhat complicated. ACIP recommends that patients with certain underlying medical conditions or with functional or anatomic asplenia should receive a second dose of PPSV23 5 years after the first dose. In addition, no more than 2 doses of PPSV23 should be given prior to age 65. Refer to the CDC’s specific recommendations and dosing charts for more information.

Adults who are 65 or older who smoke or have chronic conditions such as alcoholism, asthma, diabetes, or heart disease should receive PPSV23 only.

Prior to the ACIP 2013 recommendation, the American Academy of Pediatrics (AAP) had issued a policy statement recommending offering a dose of PCV13 to high-risk children aged 6 to 18. The initial licensure studies for PCV13 did not include children in this age range, and the AAP categorized its off-label recommendation as “permissive.” It suggested offering the vaccine to PCV13-naive children with asplenia, cochlear implants, cerebrospinal fluid leaks, HIV, chronic renal failure, and other immunodeficient conditions. The ACIP has now voted to make this a routine recommendation.

As always, immunizers who discuss pneumococcal disease and the need for vaccination with their patients should use it as an opportunity to discuss other vaccinations.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.