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CME: Updating Pneumococcal Vaccine Recommendations

CME: Updating Pneumococcal Vaccine Recommendations
Author Information (click to view)

Tamara Pilishvili, MPH

Epidemiologist, Respiratory Diseases Branch
National Center for Immunization & Respiratory Diseases
Centers for Disease Control & Prevention

Tamara Pilishvili, MPH, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Explain the importance of pneumococcal vaccination in adults aged 65 and older;
  2. Describe key updates made in the 2014 paper “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).”

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwjune2.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria, Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Tamara Pilishvili, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Tamara Pilishvili, MPH (click to view)

Tamara Pilishvili, MPH

Epidemiologist, Respiratory Diseases Branch
National Center for Immunization & Respiratory Diseases
Centers for Disease Control & Prevention

Tamara Pilishvili, MPH, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

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The Advisory Committee on Immunization Practices has updated its recommendations for vaccinating adults aged 65 and older against pneumococcal infections.
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Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacteria (also referred to as pneumococcus). These bacteria can cause many types of illnesses, including pneumonia, meningitis, and ear, sinus, and bloodstream infections. Pneumococcus is spread when people cough, sneeze, and/or are in close contact with others who are infected. Symptoms depend on the part of the body that is infected. They can include fever, cough, shortness of breath, chest pain, stiff neck, and confusion and disorientation. Symptoms may also include sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. In severe cases, pneumococcal disease can cause hearing loss, brain damage, and death.

Pneumococcal disease is a leading infectious cause of serious illness among older adults in the United States. Studies have identified certain patient groups that are more likely to become ill with pneumococcal disease. These high-risk groups include adults aged 65 and older and children younger than 2 years of age. People with weakened immune systems (eg, those with HIV/AIDS), those with chronic illnesses (eg, diabetes, heart disease, and asthma), and individuals who smoke cigarettes are at increased risk for getting pneumococcal disease.

Vaccines Have Helped

The incidence of pneumococcal infections among children and adults in the U.S. has dropped since a 7-valent pneumococcal conjugate vaccine (PCV7) was initiated for routine use among infants in 2000 and was later replaced by the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010. “For decades, the 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been recommended for use in adults aged 65 and older for the prevention of pneumococcal infections,” explains Tamara Pilishvili, MPH. More recently, the FDA approved PCV13 for use in adults aged 50 and older.

Pneumococal-Vaccine-Callout

When compared with 2010 data, the incidence of invasive pneumococcal disease (IPD) caused by serotypes unique to PCV13 among adults aged 65 and older declined by about 50% in 2013, thanks in large part to PCV13 replacing PCV7 in the pediatric immunization schedule. Still, an estimated 13,500 cases of IPD occurred among adults aged 65 and older in 2013. Studies show that about 20% to 25% of IPD cases and 10% of community-acquired pneumonia cases in the older adult population are caused by PCV13 serotypes and are potentially preventable with the use of this particular vaccine.

Key Updates

In 2012, with the licensure of PCV13 for adults, the Advisory Committee on Immunization Practices (ACIP) revisited its recommendations and indicated that pneumococcal vaccine-naïve individuals aged 19 and older who are immunocompromised or have functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later.

“In 2014, results of a study involving about 85,000 adults aged 65 and older with no prior pneumococcal vaccination history evaluating efficacy of PCV13 in preventing community-acquired pneumococcal pneumonia were released,” says Dr. Pilishvili. “This trial found that PCV13 was effective against community-acquired pneumonia and led ACIP to recommend routine use of PCV13 followed by PPSV23 in this older patient population. ACIP indicated that both PCV13 and PPSV23 should be routinely administered in series to all adults aged 65 and older to achieve broader protection against IPD.”

Sequencing & Intervals

ACIP also provided guidance on the sequential administration and recommended intervals for PCV13 and PPSV23 for adults aged 65 and older (Figure). Older adults who have not previously received pneumococcal vaccines or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. “The dose of PPSV23 should be given 6 to 12 months after a dose of PCV13,” Dr. Pilishvili says. “If PPSV23 cannot be given during the 6-to-12-month window, the PPSV23 dose should be given during the patient’s next visit. The two vaccines should not be coadministered, and the minimum acceptable interval between PCV13 and PPSV23 is 2 months. Healthcare providers should be offering a dose of PCV13 to both vaccine-naïve adults aged 65 years and older as well as those who previously received one or more doses of PPSV23.”

The ACIP recommendations also note that older adults who previously received one or more doses of PPSV23 also should receive a PCV13 dose if they have not yet received it. A PCV13 dose should be given 1 or more years after receipt of the most recent PPSV23 dose. Among appropriate candidates for additional doses of PPSV23, the subsequent PPSV23 dose should be given 6 to 12 months after PCV13 and at 5 years or later after the most recent dose of PPSV23.

Important Considerations

According to Dr. Pilishvili, the recommendations for pneumococcal vaccination use among adults aged 65 and older will be reevaluated in 2018 and revised as needed. “The updated guidance from ACIP may be complicated for healthcare providers but allows for flexibility if doses are not given within the recommended window or if previous vaccination history is unknown,” she says. “It’s important to be vigilant about offering these vaccinations to adults as indicated. The better that healthcare providers are at adhering to these recommendations, the more likely we are to optimize protection against pneumococcus in older adults.”

Readings & Resources (click to view)

Tomczyk S, Bennett NM, Stoecker C, 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 Morb Mortal Wkly Rep. 2014;63:822-825. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm and http://www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm.

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 Morb Mortal Wkly Rep. 2012;61:816-819.

CDC. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59:1102-1106.

Jackson LA, Gurtman A, van Cleeff M, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults. Vaccine. 2013;31:3577-3584.

Jackson LA, Gurtman A, Rice K, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine. 2013;31:3585-3593.

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