Navigating pneumococcal vaccination in adults

doi:10.3949/ccjm.83a.15044

Article

Navigating pneumococcal vaccination in adults

J Fam Pract. 2016 June;65(6):427-433 | 10.3949/ccjm.83a.15044

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References

Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance report (ABCs). ABCs Report: Streptococcus pneumoniae, 2010. www.cdc.gov/abcs/reports-findings/survreports/spneu10-orig.html. Accessed May 13, 2016.
Said MA, Johnson, HL, Nonyane BA, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. Plos One. 2013;8:e60273.
Tomczyk S, Bennett NM, Stoecker C, et al; Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63:822–825.
Crum-Cianflone NF, Huppler Hullsiek K, Roediger M, et al; Infectious Disease Clinical Research Program HIV Working Group. A randomized clinical trial comparing revaccination with pneumococcal conjugate vaccine to polysaccharide vaccine among HIV-infected adults. J Infect Dis. 2010:202:1114–1125.
Jackson LA, Gurtman A, van Cleeff M, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naïve adults. Vaccine. 2013;31:3577–3584.
Jackson LA, Neuzil KM, Yu O, et al; Vaccine Safety Datalink. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med. 2003;348:1747–1755.
Bonten M, Huijts S, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372:1114–1125.
Lesprit P, Pedrono G, Molina JM, et al; ANRS 114-Pneumovac Study Group. Immunological efficacy of a prime-boosted pneumococcal vaccination in HIV-infected adults. AIDS. 2007;21:2425–2434.
Feikin DR, Elie CM, Goetz MB, et al. Randomized trial of the quantitative and functional antibody responses to a 7-valent pneumococcal conjugate vaccine and/or 23-valent polysaccharide vaccine among HIV-infected adults. Vaccine. 2001;20:545–553.
French N, Gordon SB, Mwalukomo T, et al. A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults. N Engl J Med. 2010;362:812–822.
Jackson LA, Gurtman A, Rice K, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine. 2013;31:3585–3593.
Greenberg RN, Gurtman A, French RW, et al. Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naïve adults 60-64 years of age. Vaccine. 2014;32:2364–2374.
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010:59:1102–1106.
Kobayashi M, Bennett NM, Gierke R, et al. Centers for Disease Control and Prevention (CDC). Intervals between PCV13 and PPSV23; Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 2015;64:944-947.
Department of Health and Human Services; Centers for Medicare and Medicaid Services. Modifications to Medicare Part B coverage of pneumococcal vaccinations. www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf. Accessed May 13, 2016.
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61:816–819.
Williams WW, Lu PJ, O’Halloran A, et al; Centers for Disease Control and Prevention (CDC). Noninfluenza vaccination coverage among adults - United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64:95–102.
Rehm SJ, File TM, Metersky M, Nichol KL, Schaffner W; National Foundation for Infectious Diseases Pneumococcal Disease Advisory Board. Identifying barriers to adult pneumococcal vaccination: an NFID task force meeting. Postgrad Med. 2012;124:71–79.
Centers for Disease Control and Prevention (CDC). Vaccines and immunizations. PCV13 (pneumococcal conjugate) vaccine. Recommendations, scenarios and Q&As for healthcare professionals about PCV13 for adults. www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm. Accessed May 13, 2016.
Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2008;57:1–30.
Immunization Action Coalition. Ask the experts: diseases & vaccines. Pneumococcal vaccines (PCV13 and PPSV23). www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp. Accessed May 13, 2016.

FIGURE 3. Intervals of administration of pneumococcal conjugate vaccine-13 (PCV13) and pneumococcal polysaccharide vaccine-23 (PPSV23) in immunocompromised patients.Information from reference 16.

ADDRESSING BARRIERS TO PNEUMOCOCCAL VACCINATION

In 2013, only 59.7% of adults age 65 and older and 21.1% of younger, at-risk adults with immunocompromising conditions had received pneumococcal vaccination.¹⁷ Healthcare providers have the opportunity to improve pneumococcal vaccination rates. The National Foundation for Infectious Diseases (www.nfid.org) summarized challenges in vaccinating at-risk patients and recommended strategies to overcome barriers.¹⁸

Challenges include the cost of vaccine coverage, limited time (with competing priorities during office appointments or hospitalizations), patient refusal, and knowledge gaps.

Strategies to overcome barriers include incorporating vaccination into protocols and procedures; educating healthcare providers and patients about pneumococcal disease, vaccines, costs, and reimbursement; engaging nonclinical staff members; and monitoring local vaccination rates. However, the most important factor affecting whether adults are vaccinated is whether the healthcare provider recommends it.

AN OPPORTUNITY TO IMPROVE

In the last 30 years, great strides have been made in recognizing and preventing pneumococcal disease, but challenges remain. Adherence to the new ACIP guidelines for pneumococcal vaccination in immunocompromised, at risk and elderly patients is important in reducing invasive pneumococcal disease.

Healthcare providers have the opportunity to improve pneumococcal vaccination rates at outpatient appointments to decrease the burden of invasive pneumococcal disease in at-risk populations. A comprehensive understanding of the guideline recommendations for pneumococcal vaccination can aid the provider in identifying patients who are eligible for vaccination.

Adult pneumococcal immunization rates are low due to missed opportunities. Healthcare providers can improve these rates by viewing every patient encounter as a chance to provide vaccination.

TAKE THE POST-TEST AND COMPLETE THE CME PROCESS

References

Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance report (ABCs). ABCs Report: Streptococcus pneumoniae, 2010. www.cdc.gov/abcs/reports-findings/survreports/spneu10-orig.html. Accessed May 13, 2016.
Said MA, Johnson, HL, Nonyane BA, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. Plos One. 2013;8:e60273.
Tomczyk S, Bennett NM, Stoecker C, et al; Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63:822–825.
Crum-Cianflone NF, Huppler Hullsiek K, Roediger M, et al; Infectious Disease Clinical Research Program HIV Working Group. A randomized clinical trial comparing revaccination with pneumococcal conjugate vaccine to polysaccharide vaccine among HIV-infected adults. J Infect Dis. 2010:202:1114–1125.
Jackson LA, Gurtman A, van Cleeff M, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naïve adults. Vaccine. 2013;31:3577–3584.
Jackson LA, Neuzil KM, Yu O, et al; Vaccine Safety Datalink. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med. 2003;348:1747–1755.
Bonten M, Huijts S, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372:1114–1125.
Lesprit P, Pedrono G, Molina JM, et al; ANRS 114-Pneumovac Study Group. Immunological efficacy of a prime-boosted pneumococcal vaccination in HIV-infected adults. AIDS. 2007;21:2425–2434.
Feikin DR, Elie CM, Goetz MB, et al. Randomized trial of the quantitative and functional antibody responses to a 7-valent pneumococcal conjugate vaccine and/or 23-valent polysaccharide vaccine among HIV-infected adults. Vaccine. 2001;20:545–553.
French N, Gordon SB, Mwalukomo T, et al. A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults. N Engl J Med. 2010;362:812–822.
Jackson LA, Gurtman A, Rice K, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine. 2013;31:3585–3593.
Greenberg RN, Gurtman A, French RW, et al. Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naïve adults 60-64 years of age. Vaccine. 2014;32:2364–2374.
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010:59:1102–1106.
Kobayashi M, Bennett NM, Gierke R, et al. Centers for Disease Control and Prevention (CDC). Intervals between PCV13 and PPSV23; Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep. 2015;64:944-947.
Department of Health and Human Services; Centers for Medicare and Medicaid Services. Modifications to Medicare Part B coverage of pneumococcal vaccinations. www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf. Accessed May 13, 2016.
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61:816–819.
Williams WW, Lu PJ, O’Halloran A, et al; Centers for Disease Control and Prevention (CDC). Noninfluenza vaccination coverage among adults - United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64:95–102.
Rehm SJ, File TM, Metersky M, Nichol KL, Schaffner W; National Foundation for Infectious Diseases Pneumococcal Disease Advisory Board. Identifying barriers to adult pneumococcal vaccination: an NFID task force meeting. Postgrad Med. 2012;124:71–79.
Centers for Disease Control and Prevention (CDC). Vaccines and immunizations. PCV13 (pneumococcal conjugate) vaccine. Recommendations, scenarios and Q&As for healthcare professionals about PCV13 for adults. www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm. Accessed May 13, 2016.
Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2008;57:1–30.
Immunization Action Coalition. Ask the experts: diseases & vaccines. Pneumococcal vaccines (PCV13 and PPSV23). www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp. Accessed May 13, 2016.

Navigating pneumococcal vaccination in adults

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