USPharmacist | Weekly News Update



Advertisement Advertisement	October 1, 2014 New Guidance on Pneumonia Vaccines for Older Adults Atlanta—Based on new recommendations from the CDC, adults 65 years or older should now receive both the pneumococcal conjugate vaccine (PCV13, Prevnar-13) and the pneumococcal polysaccharide vaccine (PPSV23, Pneumovax23). The advisory, published in a recent edition of the Morbidity and Mortality Weekly Report, also said that adults 65 years of age or older who have not previously received any pneumococcal vaccines or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed later by a dose of PPSV23. Those who previously received PPSV23 should receive the additional vaccine at least one year after their most recent dose of PPSV23, the CDC noted. The Advisory Committee on Immunization Practices (ACIP) recommended routine use of 13-valent pneumococcal conjugate vaccine in August. The determination was made after reviewing evidence of a randomized placebo-controlled trial evaluating efficacy of PCV13 for preventing community-acquired pneumonia among approximately 85,000 adults 65 and older with no prior pneumococcal vaccination history in the CAPiTA trial. PCV13 was approved by the FDA in late 2011 for use among adults 50 and older. Routine use of PCV13 for adults aged 19 years and older with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants was recommended in 2012, but the ACIP deferred its decision on widespread use of the vaccine in older adults until more data became available. The results of the Netherlands-based CAPiTA trial demonstrated 45.6% efficacy of PCV13 against vaccine-type pneumococcal pneumonia, 45.0% efficacy against vaccine-type nonbacteremic pneumococcal pneumonia, and 75.0% efficacy against vaccine-type invasive pneumococcal disease (IPD) among adults aged 65 and older. Furthermore, two randomized, multicenter, immunogenicity studies conducted in the United States and Europe among older adults showed that PCV13 induced an immune response as good as or better than that induced by PPSV23 without greater safety issues. The CDC pointed out that Streptococcus pneumoniae (pneumococcus) remains a leading infectious cause of serious illness, including bacteremia, meningitis, and pneumonia, among older adults in the United States. On the other hand, use of a 7-valent pneumococcal conjugate vaccine (PCV7) since 2000 and PCV13 since 2010 among children in the United States has reduced pneumococcal infections directly and indirectly among children, and indirectly among adults. In fact, by 2013, the incidence of IPD caused by serotypes unique to PCV13 among adults aged 65 or older had declined by approximately 50% compared with 2010, when PCV13 replaced PCV7 in the pediatric immunization schedule. Clinical trials indicated that adverse reactions were similar to the previous vaccines and include pain, redness, and swelling at the injection site; limitation of movement of the arm in which the injection was given; fatigue; headache; chills; decreased appetite; generalized muscle pain; and joint pain. Both PCV13 and PPSV23 should be administered routinely in a series to all adults aged 65 or older, according to the ACIP recommendations. The two vaccines should not be co-administered, however, and the minimum acceptable interval between PCV13 and PPSV23 is eight weeks, the advisory committee said. Concomitant administration of PCV13 and trivalent inactivated influenza vaccine (TIV) has been demonstrated to be immunogenic and safe, but no data currently are available on co-administration with other vaccines, including tetanus, diphtheria, and acellular pertussis vaccine or zoster vaccine among adults, the CDC advised. Before administering PCV13, vaccination providers are urged to consult the package insert for precautions, warnings, and contraindications. Vaccination with PCV13 is contraindicated in persons known to have a severe allergic reaction such as anaphylaxis to any component of PCV13 or PCV7 or to any diphtheria toxoid–containing vaccine. Click here for October 1, 2014 USP Weekly News Update.
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