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pneumococcal vaccine

Indications: - prevention of pneumonia due to Streptococcus pneumoniae - adults >= 65 years of age [2] - or >= 19 years of age with: - immunocompromised condition (HIV, cancer, renal disease)* - functional or anatomic asplenia* - immunosuppression - pneumococcal vaccination associated with lower risk for both mild & severe respiratory infections in patients taking long-term immunosuppressants [18] - immuncompetent patients* - CSF leaks, or cochlear implants* - COPD, smoking, heart disease* - diabetes mellitus, chronic liver disease, alcoholism* - chronic renal failure [3]* - hemoglobinopathy* - comparison of protection from different pneumococcal vaccines: [12] vaccine serotypes for which protection afforded PCV13 Block-1 PCV15 Block-1 + Block-2 PCV20 Block-1 + Block-2 + Block-3 PPSV23 Block-1 + Block-2 + Block-3 + Block-4 (except 6A in Block-1) Block-1: serotypes: 1, 2, 3, 4, 5, 6A, 6B, 7F,14, 18C, 19A, 19F, 23F Block-2: serotypes: 22F, 33F Block-3: serotypes: 8, 10A, 11A, 12F, 15B Block-4: serotypes: 2, 9N, 17F, 20 - for PCV20 serotype coverage, see pneumococcal conjugate vaccine Contraindications: - does not reduce risk of dementia - may increase incidence of dementia in the elderly after a 2-year lag period [13] - hypersensitivity to pneumococcal vaccine, diptheria toxoid or any component Management: - Advisory Committee on Immunization Practices (ACIP) recommends routine use of: - 15-valent pneumococcal conjugate vaccine (Prevnar)* + 23-valent pneumococcal polysaccharide vaccine (Pneumovax) in this order 1 year later (CDC) [7] - 20-valent Prevnar (PCV20) without Pneumovax (PPSV23) 1 year later is alternative [7] - FDA approves Capvaxive (Pneumococcal 21-valent Conjugate Vaccine) [17] - PCV13 no longer recommended (except for nursing home residents) [9], & PCV15 & PCV20 have replaced need for PCV13 - PCV13 had been recommended for elderly with immunosupression & for elderly with a CSF leak or a cochlear implant [8] Vaccination schedule for PCV13 recipients [10] prior vaccination vaccines needed PCV13 + PPSV23 PCV20 >= 5 years after previous dose PCV13 only & healthy PPSV23 or PCV20 at age 65 PCV13 only & immunocompromised PPSV23 or PCV20 & repeat at age 65 * at least 1 year between vaccines - older adults who have not previously received either vaccine should be given one dose of Prevnar (PCV15) followed by one dose of Pneumovax (PPSV23) 1 year later (CDC) [7] - interval beween doses may be shortened to 8 weeks if high immediate risk - do not give PCV13 to older adults - Prevnar (PCV20) is alternative to Prevnar (PCV15) + Pneumovax (PPSV23) - adults who have previously received Pneumovax should be given one dose of Prevnar (PCV15) or PCV20 at least 1 year after the last Pneumovax dose - if a patient received both PCV13 + PPSV23 before age 65, PCV20 should be adminisered 5 years later - if patient received either (PCV13 or PSV15) or PPSV23 before age 65, but not both, PCV20 may be administered after 1 year - PCV20 may be administered to patients who have received PCV13 at any age & PPSV23 at age >= 65 years (5 years after PPSV23) - if a patient received a PPSV23 dose before age 65, a 2nd dose should be administered 5 years later if Prevnar is not administered - do not give PCV13 - no longer recommended because the risk of PCV13 serotype is lower in adults >= 65 because of decreased carriage & transmission from children - PCV13 is expensive & unnecessary for healthy elderly [5] - PCV13 use was associated with reduced pneumonia hospitalization among Medicare beneficiaries >= 65 years [11] - this would seem to implicate S pneumoniae serotype 6A (the only serotype not covered by PPSV23) - in adults 65-74 years adjusted vaccine effectiveness (aVE) of PCV13 alone for preventing pneumococcal CAP is 66%, for PPSV23 alone, aVE is 18.5%, & for sequential PCV13/PPSV23 aVE is 80% [6]; - PPSV23 alone aVE is 50-80% [8] - previous guidelines in 2021 recommended use of PPSV23 alone (2 doses) or PCV13 followed by PPSV23 [16] * PSV15 & PSV20 replace PSV13 in 2022 [7] * both PSV15 & PPSV23 recommended for immunocompromised patients & immunocompetent patients < 65 years of age who qualify [4,7] * PSV20 recommended for immunocompetent patients < 65 years of age [4]

Specific

pneumococcal congugate vaccine (Prevnar, Prevnar 13, PCV13, Prevnar-20, PCV20, Prevnar-15, PCV15, Vaxneuvance, Capavaxive, PCV21, PHiD-CV10, PCV10, Synflorix) pneumococcal polysaccharide vaccine, polyvalent (PneumoVax 23, Pnu-Immune 23, PPSV-23)

General

vaccine

References

  1. Centers for Disease Control & Prevention 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 October 12, 2012 / 61(40);816-819 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm
  2. Tomczyk S et al Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >= 65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Weekly. September 19, 2014 / 63(37);822-825 PMID: 25233284 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm
  3. Kobayashi M et al Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Weekly. September 4, 2015 / 64(34);944-947 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. Board Basics. An Enhancement to MKSAP19. 2023 American College of Physicians, Philadelphia 2015, 2018, 20219.
  5. Zuger A How Should We Use Conjugate Pneumococcal Vaccine in Immunocompetent Older Adults? NEJM Journal Watch. Jukt 25, 2019 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
  6. Heo JY, Seo YB, Choi WS et al. Effectiveness of pneumococcal vaccination against hospitalized pneumococcal pneumonia in older adults: A prospective, test-negative study. J Infect Dis 2021 Sep 19; [e-pub] PMID: 34537847 https://academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiab474/6372439
  7. Melville NA CDC Issues New Pneumococcal Vaccine Recommendations for Adults. Medscape. Feb 1, 2022 - Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109-117 PMID: 35085226 Free article https://www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm - Centers for Disease Control and Prevention. Pneumococcal vaccination: Information for healthcare professionals. CDC 2022 Jan 24 https://www.cdc.gov/vaccines/vpd/pneumo/hcp/index.html
  8. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  9. Matanock A, Lee G, Gierke R, et al. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >=65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:1069-1075 PMID: 31751323 PMCID: PMC6871896 Free PMC article
  10. Sax PE Five Quick Questions from Our Course " ID in Primary Care" HIV and ID Observations. Nov 7, 2022 https://blogs.jwatch.org/hiv-id-observations/index.php/five-quick-questions-from-our-course-id-in-primary-care/2022/11/07/
  11. Kobayashi M et al. Association of pneumococcal conjugate vaccine use with hospitalized pneumonia in Medicare beneficiaries 65 years or older with and without medical conditions, 2014 to 2017. JAMA Intern Med 2023 Jan; 183:40. PMID: 36469350 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2799225
  12. From The Medical Letter on Drugs and Therapeutics. December 28, 2021 Two New Pneumococcal Vaccines - Prevnar 20 and Vaxneuvance JAMA. 2021;326(24):2521-2522. PMID: 34962532 https://jamanetwork.com/journals/jama/fullarticle/2787554
  13. Douros A et al. Common vaccines and the risk of incident dementia: A population-based cohort study. J Infect Dis 2022 Dec 21; [e-pub]. PMID: 36542511 https://academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiac484/6948438 - Salmon DA et al. Commentary on "Common vaccines and the risk of dementia: a population-based cohort study": Science can be messy but eventually leads to truths. J Infect Dis 2022 Dec 21; [e-pub] PMID: 36542509 https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac487/6950650
  14. Prevnar20 https://prevnar20adult.pfizerpro.com/acip-recommendations
  15. Centers for Disease Control & Prevention Public Health Surveillance. September 29, 2023 2016-2021 Serotype Data for Invasive Pneumococcal Disease Cases by Age Group from Active Bacterial Core surveillance https://data.cdc.gov/Public-Health-Surveillance/2016-2021-Serotype-Data-for-Invasive-Pneumococcal-/qvzb-qs6p
  16. Kobayashi M, Pilishvili T, Farrar JL et al. Pneumococcal vaccine for adults aged >= 19 years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep. 2023 Sep 8;72(3):1-39. PMID: 37669242 PMCID: PMC10495181 Free PMC article. https://www.cdc.gov/mmwr/volumes/72/rr/rr7203a1.htm
  17. Ellis R FDA Approves New Pneumococcal Vaccine. Medscape. June 18, 2023 https://www.medscape.com/viewarticle/fda-approves-new-pneumococcal-vaccine-2024a1000bcm
  18. Nakafero G et al. Effectiveness of pneumococcal vaccination in adults with common immune-mediated inflammatory diseases in the UK: A case-control study. Lancet Rheumatol 2024 Sep; 6:e615. PMID: 39067457 Free article https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(24)00128-0/fulltext