Pneumonia Vaccine – Who Should Get It And When?

Pneumonia Vaccine – Who Should Get It And When?

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Pneumococcal diseases can cause critical infections such as pneumonia, sepsis, and meningitis. Although more common in children, adults are at greater risk of serious complications and death from these infections. Currently, there are two vaccines that can help prevent pneumococcal disease: Prevnar 13 and Pneumovax 23. Knowing which to give and to which age group can be challenging. Childhood vaccine schedules have already implemented Prevnar 13 as a routine immunization. However, knowing when to administer Prevnar 13 and PPSV23 to adults can be a bit more difficult. Certain adult age groups are prone to complications and need both vaccines to be a set amount of years apart. Having a guide detailing which vaccine is appropriate for which age group and or high-risk population is extremely helpful when physicians recommend the vaccine to their patients. 

Prevnar 13 (PCV13)  is used primarily with children and in some high-risk adults. It helps protect against multiple Streptococcus pneumoniae serotypes.  Specifically it targets Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Studies have shown that the US incidence of invasive pneumococcal disease had declined by 87% since the introduction of Prevnar 13 in 2010. This intramuscular injection is given to children as a four dose series: at 2, 4, 6, and somewhere between 12 to 15 months. Additionally, adults 19 to <65 can be given Prevnar 13 if they are immunocompetent, immunocompromised or if they have functional or anatomic asplenia. Routine vaccination for adults >65 with Prevnar 13 is not recommended. However, ACIP advises the decision to be clinician driven if they feel Prevnar 13  is appropriate for that age group; only patients who are at high risk are often given the vaccine. They include nursing home patients, those residing in low pediatric PCV13 uptake and those traveling to regions where there is no PCV13 immunization program. 

Pneumovax 23 (PPSV23) is used for adults greater than 50 years old and >2 years old who are at an increased risk of pneumococcal disease. This vaccine targets Streptococcus pneumoniae serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F.  A 14-year retrospective study found that PPSV23 resulted in a 57% reduction of disease in adults with certain chronic conditions. This vaccine can be given either intramuscularly or subcutaneously. A single dose of Pneumovax 23 is recommended in adults 19-64 who are at an increased risk for pneumococcal infections like chronic heart disease or alcohol use disorder.  Additionally, Pneumovax 23 vaccine is indicated for all adults >65 years old since incidence increases after this age. 

In conclusion, the need to vaccinate against pneumococcal disease is essential to lessen the likelihood of getting the infection. Streptococcus pneumoniae is the main bacterial cause of pneumonia which causes both morbidity and mortality globally. Both Prevnar 13 and Pneumovax 23 help protect against the disease. However, having a basic understanding of when to give each vaccine and to whom is extremely challenging and at times confusing. 

Below is a concise guide summarizing the main highlights of this article of when to give each vaccine and to whom:

Prevnar 13 (PCV13)

  • Types of bacteria it targets: 13 types of pneumococcal bacteria
  • Who is it for: Primarily for children. At times for high-risk adults
  • Administration: Intramuscularly
  • When it should be given:
    • 4 dose series for children: 12-15 months, ages 2, 4 and 6
    • >19YO with the below: cochlear implants, CSF leaks, congenital or acquired asplenia, sickle cell disease, chronic renal failure, congenital or acquired immunodeficiency, generalized malignancy, HIV infection, Hodgkin disease, Iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, solid organ transplant

Pneumovax 23 (PPSV23)

  • Types of bacteria it targets: 23 types of pneumococcal bacteria
  • Who is it for: only for adults
  • Administration: Subcutaneously or intramuscularly
  • When it should be given:
    • 19-64 with: Alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, diabetes
    • If >19 YO patient received PCV 13, then >/=8weeks PPSV23 is given and revaccination of PPSV23 is done >/= 5 years after initial PPSV23 for patients with asplenia and immunocompromised patients
    • >65 YO: PPSV23 to be given. If the provider has decided to give PCV 13 then wait 1 year to give PPSV23

For more information on how PharmD Live can help identify patients in need of pneumococcal vaccines, please contact us!

References: 

Merck Vaccines. Indication for Pneumovax 23. 2020 Merck Sharp & Dohme Corp. Accessed October 28, 2020. https://www.merckvaccines.com/pneumovax23/

Musher, M Daniel.  Pneumococcal Vaccination in Adults.  In: File, Thomas and Bond Sheila. UpToDate. UpToDate, Inc.; 2020. Accessed October 28, 2020. https://www.uptodate.com/contents/pneumococcal-vaccination-in-adults?search=pneumovax%2023&source=search_result&selectedTitle=2~84&usage_type=default&display_rank=1#H4126861631

PfizerPro. Prevnar13. 2020. Wyeth Pharmaceuticals. Accessed October 28, 2020. https://www.pfizerpro.com/product/prevnar13pediatric/hcp

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