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New Immunization Recommendation for Adults 65 and Older

By April Southwick, News and Community
November 18, 2014


In August of this year, the Advisory Committee on Immunization Practices (ACIP) made a new vaccine recommendation for adults 65 and older. Routine use of 13-valent pneumococcal conjugate vaccine (PCV13 or Prevnar 13) is now recommended for adults 65 and older. PCV13 is recommended in addition to previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23). (Morbidity and Mortality Weekly Report (MMWR), 9/19/14)

Pneumococcal pneumonia is most common in adults. Approximately 900,000 Americans are diagnosed with pneumococcal disease each year, and the disease kills thousands of adults, including 18,000 adults aged 65 and older. Thousands more end up hospitalized because of the disease. Streptococcus pneumoniae (pneumococcus) is the leading cause of bacteremia (blood infection), meningitis (infection of the covering of the brain and spinal cord), and pneumonia (lung disease). Less severe clinical diseases caused by pneumococcus also include ear and sinus infections (National Center for Immunization and Respiratory Diseases, Division of Bacterial Disease).

Older adults need the two vaccines to prevent pneumococcal disease. PCV13 protects against 13 stains of pneumococcus bacteria and PPSV23 protects against 23 strains of pneumococcus bacteria. Together, the two vaccines decrease the incidence of disease, illness, hospitalization and even death.

It is important for adults to talk to their healthcare providers to make sure they are up to date on these recommended vaccines. Adults aged 65 and older that have never had pneumococcal vaccine, should receive PCV13 first, followed by PPSV23  6-12 months later.  Adults previously vaccinated with PPSV23 at the age of 65 and older should receive PCV13 at least 1 year after the most recent dose of PPSV23. If individuals were vaccinated prior to the age of 65 years with PPSV23 and are now aged 65 or older, they should receive PCV13 now and 6-12 months later PPSV23.   A minimum interval of 8 weeks is recommended between PCV13 and PPSV23 and may be recommended by your healthcare provider.  Following these recommended schedules will provide the best immune response.

PCV13 and PPSV23 are also recommended for adults 19 and older, with certain medical conditions such as immunocompromising conditions, asplenia (absence of spleen), cerebrospinal fluid (CSF) leaks, or cochlear implants (MMWR, 10/12/12) .  All adults should meet with a healthcare provider to determine which vaccines are recommended for them.

These vaccines are safe, but side effects can occur. Most side effects are mild and may include a sore arm, swelling, or redness at the injection site.

It is important for adults to review coverage of pneumococcal vaccines with their insurance prior to getting the vaccine(s) as each plan decides its own reimbursement rate which may vary by plan and patient group. If enrolled in Medicare, individuals should check with their Part B benefit for coverage. Currently Medicare Part B typically covers the 1st dose of pneumococcal vaccine.

References:

Centers for Disease Control and Prevention. Use of 13 -valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged 65 years and older: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014; 63(37):822-825.

Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal conjugate vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012; 61(40);816-819.

National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases.

St. Luke's Travel Medicine and Immunization Clinic

 

About The Author

April Southwick, RN, NP, MPH, MSN is a certified adult and geriatric nurse practitioner. She has practiced with St. Luke's Occupational Health, and is involved in travel medicine. April is a member of the International Society of Travel Medicine and has a Certificate in Travel Health.