Nov 2019 PrecisionVaccinations


Pneumococcal vaccination recommendations have undergone several changes in recent years, causing confusion for those who need to select a preventive vaccine. Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium that has more than 90 serotypes. Only a few of these serotypes produce the majority of invasive pneumococcal disease (IPD). On November 22, 2019, the Centers for Disease Control and Prevention (CDC) announced another change to the IPD preventive vaccine schedule. This change should clarify which of the available vaccines are best for seniors over the age of 65 years.  

The CDC now says the PCV13 vaccination is no longer routinely recommended for those seniors.

Instead, a shared clinical decision-making process is now recommended for those seniors who do not have an immunocompromising condition, CSF leak, or cochlear implant and who have not previously received the PCV13 vaccine. Furthermore, the CDC’s vaccine committee continues to recommend that all seniors (65+ yrs) receive 1 dose of PPSV23. 

The PPSV23 vaccine contains 12 serotypes in common with PCV13 and an additional 11 serotypes, for which there are no indirect effects from PCV13 use in children.  The additional 11 serotypes account for 32–37 percent of IPD among seniors. And, those seniors who received at least 1 dose of PPSV23 before age 65 years should receive 1 additional dose of PPSV23 at age ≥65 years, at least 5 years after the previous PPSV23 dose. "The CDC's recommendation to change PVC13 from a universal recommendation to a shared clinical decision between healthcare providers and patients 65 and older means each vaccination would be personalised," said Crockett Tidwell RPh, CDE, United Supermarkets Pharmacy. "It is important to discuss your options with a healthcare provider to determine which vaccines are best for you," concluded Tidwell.

Pneumococcal disease is spread from person to person by droplets in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. There are 2 major clinical syndromes of invasive pneumococcal disease: bacteremia, and meningitis. They are both caused by infection with the same bacteria but have different manifestations. Pneumococcal pneumonia is the most common disease caused by pneumococcal infection and can occur in combination with bacteremia and/or meningitis, or it can occur alone.  Isolated pneumococcal pneumonia is not considered an invasive disease, but it can be severe. 

It is estimated that 175,000 cases occur each year in the USA. The fatality rate is 5-7 percent and could be much higher in the elderly, says the CDC. Pneumococcal bacteremia occurs in about 25–30 percent of patients with pneumococcal pneumonia. More than 50,000 cases of pneumococcal bacteremia occur each year in the USA. Bacteremia is the most common clinical presentation among children less than 2 years of age, accounting for 70 percent of invasive disease in this age group. Pneumococci cause 50 percent of all cases of bacterial meningitis in the USA.  There are 3,000-6,000 cases of pneumococcal meningitis each year. Symptoms and signs may include headache, tiredness, vomiting, irritability, fever, seizures, and coma.  Children less than 1 year of age have the highest rate of pneumococcal meningitis. And the case-fatality rate of pneumococcal meningitis is about 8 percent among children and 22 percent among adults.

The CDC’s recommendations for use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). The ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the CDC. Since these vaccination suggestions have changed and could be confusing, the CDC suggests everyone speak to a healthcare provider to learn which vaccine is best for their needs.

And, since any vaccine can cause a side effect, if you experience one, please report it to a healthcare provider.

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