2015 ACIP Adult Schedule Highlights Pneumococcal Vaccine

Miriam E. Tucker

February 02, 2015

All adults aged 65 years and older should now receive the 13-valent pneumococcal conjugate vaccine (PCV13/Prevnar 13, Wyeth), in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23/Pneumovax 23, Merck), according to the 2015 adult immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC).

The new clinical guideline, "Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2015," was published online February 2 in the Annals of Internal Medicine by David K. Kim, MD, from the CDC's Immunization Services Division, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, and colleagues, on behalf of the ACIP. The recommendations are also published on the CDC's website.

Previously, ACIP recommended PCV13 followed at least 8 weeks later with PPSV23 for adults aged 19 years and older with immunocompromising conditions or certain other chronic health conditions; a second dose of PPSV23 was recommended 5 years after the first.

In August 2014, ACIP recommended routine use of PCV13 in a series with PPSV23 for all adults aged 65 years and older who were not previously vaccinated with it, followed by PPSV23 6 to 12 months later. That recommendation became CDC policy in September 2014 and is now formally published in the 2015 adult schedule.

Coinciding with the new recommendation, as of February 2, Medicare will cover an initial pneumococcal vaccine for beneficiaries who have never received a pneumococcal vaccine under Part B, and then a different, second pneumococcal vaccine 1 year after the first one.

Dr Kim and colleagues note that vaccinating adults with both PCV13 and PPSV23 is "challenging," because the timing, frequency, and intervals between doses depend on the patient's age, health condition, vaccination history, and other factors. Both the journal article and the footnote on the CDC chart provide detailed guidance.

There are about 40,000 cases of invasive pneumococcal disease annually in the United States, of which about a third occur in adults aged 65 years and older. Approximately 20% to 25% of invasive pneumococcal disease cases and 10% of community-acquired pneumonia cases are caused by PCV13 serotypes.

In an accompanying editorial, Sandra Adamson Fryhofer, MD, an Atlanta-based internist who serves as the liaison to ACIP from the American College of Physicians, said the expanded recommendation was based on data from a randomized trial of nearly 85,000 seniors showing that PCV13 was about 45% effective in preventing pneumonia caused by one of the vaccine's 13 strains and in preventing 75% of vaccine-type invasive pneumococcal disease cases.

Dr Kim and colleagues point out that the overall 2013 pneumococcal vaccination coverage rate among adults aged 65 years and older was just 59.7%, and for those at high risk aged 19 to 64 years, it was just 21.2%, which is only slightly above the 2012 rates and well below the Healthy People 2020 targets of 90% and 60%, respectively.

"Health care providers have an opportunity to make a significant impact in reducing the morbidity of pneumococcal disease among adults by ensuring that their patients are up to date on their pneumococcal vaccinations," the authors write.

Indeed, Dr Fryhofer says, "The ACIP recommendations are both thoughtful and evidence-based, but they cannot prevent disease unless implemented. Physicians must do all they can to increase vaccination rates. The proportion of eligible patients vaccinated is the real measure of success."

The authors and Dr Fryhofer have disclosed no relevant financial relationships.

Ann Intern Med. Published online February 2, 2015.

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