Pneumococcal Vaccination

Clinical Guidelines—Pneumococcal Vaccination in Older Adults for the Prevention of Pneumococcal Disease

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Background

Pneumococcal disease is

• an invasive disease from Streptococcus pneumoniae (pneumococcus),

• the leading cause of vaccine-preventable illness and death in the U.S., and

• more dangerous to young children and the elderly (≥65).

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Transmission

Pneumococcus is

•found in many people’s noses and throats as a type of bacteria, and

•spread by coughing, sneezing or via contact with respiratory secretions.

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Everybody Is at Risk

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Those at Greatest RiskAge Factors

The Very Young ≥65 Adults

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Those at Greatest RiskUnderlying Conditions

Long-Term Health Problems

Weakened Immune System

Heart or lung disease, sickle cell, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid, cochlear implant

Hodgkin’s lymphoma, leukemia, kidney failure, multiple myeloma, nephrotic syndrome, HIV or AIDS, damaged or no spleen, organ transplant

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Those at Greatest RiskWeakened Respiratory Systems

Smokers Asthma Sufferers

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Clinical Syndromes

lungs (pneumonia)

blood (bacteremia)

covering of the brain(meningitis)

Pneumoccocus leads to serious infections of the

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Clinical SyndromesMortality Rates

Pneumonia

1 in 20

deaths

Bacteremia

1 in 5

deaths

Meningitis

3 in 10

deaths

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Clinical SyndromesMortality Rates

The highest mortality for bacteremia and meningitis occurs among the elderly and patients with underlying conditions.

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Pneumonia

• Most common disease caused by pneumococcal infection

• 175,000 estimated U.S. cases annually

• Occurs alone or in combination with bacteremia and/or meningitis

• Not considered invasive but can be severe when isolated

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Pneumonia

• 1–3 day incubation period

• 5–7% fatality rate (may be much higher among elderly)

• Accounts for 36% of adult community-acquired pneumonia; 50% of hospital-acquired pneumonia

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PneumoniaSymptoms

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Bacteremia

Approximately 1 in 4 patientswith pneumonia develop bacteremia

More than 5,000 U.S. cases annually

20% overall case fatality

May be as high as 60%among elderly

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BacteremiaSymptoms

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Meningitis

Accounts for 13–19% of all pneumococcal disease cases in the U.S.

Highest rate in children <1 year old

As high as 80% elderly mortality rate

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MeningitisSymptoms (Adults)

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Vaccination

Approximately half of deaths from pneumococcal disease could be prevented by vaccinations.

50%

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PPSV23 Vaccine

Pneumococcal disease has more than 90 serotypes.

The 10 most common serotypes cause 62% of invasive disease worldwide.

PPSV23 protects against 23 serotypes, including those most likely to cause serious disease.

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PPSV23 VaccineEfficacy

PPSV23 IS

•60–70% effective against invasive disease,

•very good at preventing severe disease, hospitalization and death, and

•effective at developing antibodies within 2–3 weeks in more than 80% of healthy adults.

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PPSV23 VaccineEfficacy

PPSV23 IS NOT

•a “pneumonia vaccine,”

•shown to provide protection against pneumococcal pneumonia, and

•guaranteed to prevent infection and symptoms in all people.

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PPSV23 VaccineRecommendations

Adults 65 years and older

Anyone 2–64 years old with a long-term health problem,heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of the cerebrospinal fluid or cochlear implant

Updated recommendations for prevention of invasive pneumoccocal diseaseamong adults using the PPSV23 vaccine.Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm

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PPSV23 Vaccine Recommendations

Anyone 2–64 years old with a disease or condition thatlowers the body’s resistance to infectionHodgkin’s lymphoma, leukemia, kidney failure, multiple myeloma, nephrotic syndrome, HIV infection or AIDS, damaged or no spleen, organ transplant

Anyone 2–64 years old taking a drug or treatment thatlowers the body’s resistance to infectionlong-term steroids, certain cancer drugs, radiation therapy

Any adult 19–64 years old who is a smoker or hasasthma

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PPSV23 Vaccine Recommendations

Older adults and persons with chronic illnesses or immunodeficiency may not respond well, if at all;

however,

it is still recommended because they are at high risk of developing severe disease.

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PPSV23 Vaccine Dosing

Only one dose is needed with a few exceptions.

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PPSV23 VaccineDosing Exceptions

Revaccination is recommended for•People ≥65 years who got first dose younger than 65 and more than 5 years have passed•People 2–64 years given first dose >5 years ago who have

o a damaged or no spleeno sickle-cell diseaseo HIV infection or AIDSo cancer, leukemia,

lymphoma, multiple myeloma

o nephrotic syndromeo an organ or bone marrow

transplanto to take medication that lowers

immunity (chemotherapy, long-term steroids)

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PPSV23 VaccineExclusions

Anyone

•with a life-threatening allergic reaction to PPSV23

•with a severe allergy to any component of the vaccine*

•moderately to severely ill at time of administration

•pregnant** or potentially pregnant

* See CDC Pink Book in Resources at the end of this presentation for vaccine components.** No evidence exists that PPSV23 would be harmful to a pregnant woman or her fetus.

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PPSV23 VaccineRisks

• Mild side effects (redness or pain at the injection site)

• Fever, muscle aches, or more severe local reactions in <1%

• Rare serious reaction, as with all vaccines

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PPSV23 VaccineRisks

PPSV23 cannot possibly cause pneumococcal disease.

It is an inactivated vaccine that contains only a portion of the microbe.

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PPSV23 Vaccine Medicare Coverage

Coverage includes

•Vaccine and its administration by recognized providers

•Booster vaccine for high-risk patients, if >5 years since original vaccine

•No coinsurance, copayment, or deductible requirements for patient

More detail? Centers for Medicare & Medicaid Services (CMS)

2011-2012 Immunizers’ Question & Answer Guide

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PPSV23 VaccineEndorsements

The Centers for Disease Control and Prevention

The Advisory Committee on Immunization Practices

The American Academy of Pediatrics

The American College of Obstetricians and Gynecologist

s

The American Academy of Family Physicians

The American College of Physicians

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PPSV23 VaccinePocket Guide

A laminated quick-reference tool from the CDC for front-line healthcare personnel is available.

Order here: http://www.immunize.org/ppvguide/

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Contact

Sandy Pogones

[email protected]

314-374-6451

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Resources

From the CDC:

• Clinical Information on Pneumococcal

• Updated Recommendations for the Prevention of Invasive Pneumoccal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23)

• Pneumococcal Disease In-Short

• PPSV23 What You Need to Know

• Standing Orders for Administering Pneumococcal Vaccine to Adults

• Pneumoccoccal Disease, Chapter 16 from the CDC Pink Book

From the Immunization Action Coalition:

• Ask the Experts

• Vaccine Information