Written by Matthew Son, University of Washington PharmD Candidate 2015
In September 2014, the Centers for Disease Control and Prevention (CDC) published new guidelines recommending that all adults 65 and older receive Pneumococcal Conjugate Vaccine (PCV13, brand name Prevnar-13) in addition to Pneumococcal Polysaccharide Vaccine (PPSV23, brand name Pneumovax).
What is PCV13?
PCV13 is a vaccine that protects against 13 strains of Streptococcus pneumoniae, the bacteria that causes pneumococcal disease. It is made by conjugating the outer capsule of these strains with a nontoxic protein that stimulates a strong immune response.
How do people get pneumococcal disease?
Streptococcus pneumoniae is spread through coughing or sneezing or through direct contact, such as kissing. Not everyone who carries the bacteria becomes ill, so it’s possible to “catch” pneumococcal disease from someone who appears healthy.
What happens when someone gets pneumococcal disease?
Pneumococcal disease can cause pneumonia, meningitis, or blood infection (bacteremia). Symptoms of pneumonia can include a high fever, chills, cough, shortness of breath, and chest pain. Symptoms of meningitis can include a high fever, chills, stiff neck, disorientation, and sensitivity to light. Among those who contract pneumococcal disease, those age 65 and older and adults with underlying medical conditions are at higher risk of death. For more information about types and symptoms of pneumococcal disease, please visit CDC: About Pneumococcal Disease.
Why vaccinate adults against pneumococcal disease?
In the US, 90 percent of pneumococcal disease cases are in adults. Each year, more than 30,000 cases of invasive pneumococcal disease (meningitis and bacteremia) occur in the US. Additionally, as many as 175,000 people are hospitalized due to pneumococcal pneumonia in the US each year. The case-fatality rate of pneumococcal pneumonia is 5-7 percent.
Pneumococcal disease has a high association with other complications as well. Pneumococcal meningitis can cause hearing loss, seizures, blindness, and paralysis. Concurrent cardiac events are also common among patients hospitalized with pneumococcal pneumonia.
Which adults should get PCV13?
All adults age 65 and older should get PCV13. In addition, adults age 19 through 64 years with kidney disease, immunocompromising conditions, cancer, a damaged or missing spleen, cochlear implants, or cerebro-spinal fluid (CSF) leaks should receive PCV13. For more information on adults at risk, please visit Pneumococcal Vaccination: Who Needs It?.
I have received PPSV23. Why should I get PCV13?
PPSV23 and PCV13 are made in different ways. The conjugated protein in PCV13 can cause a stronger immune response. They also provide protection from different strains of Streptococcus pneumoniae.
Why is the CDC changing their recommendations now?
This new recommendation is based on a large clinical trial that showed that adding PCV13 on top of PPSV23 in adults 65 and older reduced the rate of community acquired pneumonia by 45.6 percent and invasive pneumonia by 75 percent. For more information on the recommendation process, please visit CDC GRADE for Pneumococcal Vaccines.
When should I get PCV13?
Adults 65 and older who have not previously received pneumococcal vaccine, or who are unsure, should receive a dose of PCV13 first, then a dose of PPSV23 6-12 months later. Adults 65 and older who have previously received PPSV23 should also receive PCV13. In this case, PCV13 should be given at least 1 year after the most recent PPSV23 dose. For those whose first dose of PPSV23 was more than 5 years ago and before the age of 65, a second dose of PPSV23 should be given 6–12 months after PCV13.
Can I get the influenza and pneumococcal vaccines at the same time?
Yes. These vaccines can be given at the same time, but in different arms. In fact, pneumococcal disease can be a complication of influenza, so getting both vaccines is a smart choice. Unlike influenza vaccine, however, pneumococcal vaccination is not given every year.
What are some side effects of PCV13?
Mild side effects such as redness or pain at the injection site may occur. Very rarely, fever, muscle aches, or more severe reactions may develop.
References:
- Pneumococcal Disease: Facts About Pneumococcal Disease in Adults. http://www.adultvaccination.org/professional-resources/public-health-toolkit/patient-fact-sheet.pdf
- About Pneumococcal Disease. http://www.cdc.gov/pneumococcal/about/index.html
- Pneumococcal Disease. http://www.adultvaccination.org/pneumococcal_vaccine_vaccination_adult_immunization.htm
- Pneumococcal Vaccination: Who Needs It? http://www.cdc.gov/vaccines/vpd-vac/pneumo/vacc-in-short.htm
- Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for Pneumococcal Vaccines for Adults aged ≥65 years. http://www.cdc.gov/vaccines/acip/recs/grade/pneumo-vac-adult.html
- 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). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm#box
