UPDATE ON PNEUMOCOCCAL VACCINES CSF showing meningitis caused

UPDATE ON PNEUMOCOCCAL VACCINES CSF showing meningitis caused by S. pneumoniae Photo Credit: Content Providers(s): CDC/Dr. M. S. Mitchell - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #1003

Objectives for Today • Describe pneumococcal disease basics • Identify which adults need both PCV 13 and PPSV 23 • Indentify which adults age 19 -64 need just PPSV 23

Pneumococcal Disease • Second most common cause of vaccine preventable death in the US • Major clinical syndromes include • Pneumonia • Bacteremia • Meningitis It is better to prevent than to try and fight pneumococcal disease with antibiotics that might not work. .

Pneumococcal Pneumonia • Estimated 175, 000 hospitalizations in U. S. • Up to 36% of adult-community acquired pneumonia and 50% of hospital acquired pneumonia • Common complication (bacterial) of influenza and measles • Case fatality rate 5 -7%, much higher in elderly Pneumonia of the right middle lobe

Pneumococcal Bacteremia • More than 50, 000 cases per year in the United States • Rates higher among elderly and very young infants • Case-fatality rate ~20%; up to 60% among the elderly Septi Chek Blood Culture Bottles

Pneumococcal Meningitis • Estimated 3, 000– 6, 000 cases per year in the United States • Case-fatality rate ~30%, up to 80% in the elderly • Neurologic sequelae common among survivors • Increased risk in persons with cochlear implant Photo courtesy of CDC

The following are at HIGH RISK for PNEUMOCCAL DISEASE: ●Those ≥ 65 Years of Age ●Persons 19 -64 years with asthma or smokes cigarettes ●Persons 19 -64 with chronic illnesses

Adult 65 and Older • CDC recommends all adult ≥ 65 receive 2 types of pneumococcal vaccines • One dose of PCV 13 (first) • One dose of PPSV 23 ( 6 to 12 months after PCV vaccine) • This age group requires both vaccines for the best protection against pneumococcal disease

Adult 19 to 64 Years Who Only Need PPSV 23 • Those with chronic conditions • Asthma • Diabetes • Heart disease • Alcoholism • Liver disease • Cigarette smokers • Residents of nursing homes or other long-term care facilities • When they turn 65 this group should receive a dose of PCV 13

Adults 19 to 64 Who Should Receive both PCV 13 and PPSV 23* • Functional or anatomic asplenia† • Cochlear implants • Cerebrospinal fluid leaks† • Lymphoma, leukemia, Hodgkin disease, † • Solid organ transplants† • * PCV 13 and PPSV 23 cannot be given at the same visit • † A second PPSV 23 vaccine is recommended for these individuals five years after the first PPSV 23 dose

Age 65 Years or Older

Age 19 -64 Years with Underlying Conditions

The Centers for Medicare and Medicaid Services Update • CMS is updating their coverage to align with the new ACIP Pneumococcal Vaccine guidelines • An initial pneumococcal vaccine to who have never received the vaccine under Part B; and • A different, second pneumococcal vaccine one year after the first vaccines was administered Effective dates of service on or after September 19, 2014 and does not require that a doctor of medicine or osteopathy order the vaccines.

Scenario 1 • 66 year old patient with a cochlear implant. Previously received a PPSV 23 at age 55. What pneumococcal vaccine (s) does this patient need?

Scenario 2 • A 20 year old asthma patient shows at your clinic, asking for a shot of that” new pneumonia shot” (PCV 13). Does this patient need a PCV 13 or a PPSV 23 today?