Presentation on theme: "Update on Pneumococcal Vaccines"— Presentation transcript:
1Update on Pneumococcal Vaccines 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 #1003CSF showing meningitis caused by S. pneumoniae
2Objectives for Today Describe pneumococcal disease basics Identify which adults need both PCV13 and PPSV23Indentify which adults age need just PPSV23
3Pneumococcal DiseaseSecond most common cause of vaccine preventable death in the USMajor clinical syndromes includePneumoniaBacteremiaMeningitisStreptococcus pneumoniae in spinal fluid. FA stain digitally colorized (direct fluorescent antibody). It is estimated that 18,000 people die annually from complications of pneumococcal disease. Infants and the elderly are hit the hardest. S. pneumoniae resides asymptomatically in the nasopharynx of healthy carriers. The respiratory tract, sinuses, and nasal cavity are the parts of host body that are usually infected. However, in susceptible individuals, such as elderly and immunocompromised people and children, the bacterium may become pathogenic, spread to other locations and cause disease. S. pneumoniae is the main cause of community acquired pneumonia and meningitis in children and the elderly, and of septicemia in HIV-infected persons. The methods of transmission include sneezing, coughing, and direct contact with an infected person. Despite the name, the organism causes many types of pneumococcal infections other than pneumonia. These invasive pneumococcal diseases include bronchitis, rhinitis, acute sinusitis, otitis media, conjunctivitis, meningitis, bacteremia, sepsis, osteomyelitis, septic arthritis, Streptococcus pneumoniae is a normal inhabitant of the human upper respiratory tract. The bacterium can cause pneumonia, usually of the lobar type, paranasal sinusitis and otitis media, or meningitis, which is usually secondary to one of the former infections. It also causes osteomyelitis, septic arthritis, endocarditis, peritonitis, cellulitis and brain abscesses. Streptococcus pneumoniae is currently the leading cause of invasive bacterial disease in children and the elderly. Streptococcus pneumoniae is known in medical microbiology as the pneumococcus, referring to its morphology and its consistent involvement in pneumococcal pneumonia.endocarditis, peritonitis, pericarditis, cellulitis, and brain abscess.It is better to prevent than to try and fight pneumococcal disease with antibiotics that might not work..
4Pneumococcal Pneumonia Estimated 175,000 hospitalizations in U.S.Up to 36% of adult-community acquired pneumonia and 50% of hospital acquired pneumoniaCommon complication (bacterial) of influenza and measlesCase fatality rate 5-7%, much higher in elderlyPneumonia of the right middle lobe
5Pneumococcal Bacteremia More than 50,000 cases per year in the United StatesRates higher among elderly and very young infantsCase-fatality rate ~20%; up to 60% among the elderlySepti Chek Blood Culture Bottles
6Pneumococcal Meningitis Estimated 3,000–6,000 cases per year in the United StatesCase-fatality rate ~30%, up to 80% in the elderlyNeurologic sequelae common among survivorsIncreased risk in persons with cochlear implantPurulence covering the brain surfacePhoto courtesy of CDC
7The following are at HIGH RISK for PNEUMOCCAL DISEASE: ●Those ≥ 65 Years of Age●Persons years with asthma or smokes cigarettes●Persons with chronic illnesses
8Adult 65 and OlderCDC recommends all adult ≥ 65 receive 2 types of pneumococcal vaccinesOne dose of PCV13 (first)One dose of PPSV23 ( 6 to 12 months after PCV vaccine)This age group requires both vaccines for the best protection against pneumococcal diseaseVaccine Naïve *PCV13 and PPSV23 cannot be given at the same visit - See more at:
9Adult 19 to 64 Years Who Only Need PPSV23 Those with chronic conditionsAsthmaDiabetesHeart diseaseAlcoholismLiver diseaseCigarette smokersResidents of nursing homes or other long-term care facilitiesWhen they turn 65 this group should receive a dose of PCV13
10Adults 19 to 64 Who Should Receive both PCV13 and PPSV23* Functional or anatomic asplenia†Cochlear implantsCerebrospinal fluid leaks†Lymphoma, leukemia, Hodgkin disease,†Solid organ transplants†* PCV13 and PPSV23 cannot be given at the same visit† A second PPSV23 vaccine is recommended for these individuals five years after the first PPSV23 dose
11Age 65 Years or OlderThis came from California Department of Public Health, Immunization Branch
12Age 19-64 Years with Underlying Conditions Prior doses count towards doses recommended in figure and do not need to be repeatedIf PPSV23 given previously- wait one year before giving PCV13 and if doses is indicated, wait at least five years before giving a second dose of PPSV23
13The Centers for Medicare and Medicaid Services Update CMS is updating their coverage to align with the new ACIP Pneumococcal Vaccine guidelinesAn initial pneumococcal vaccine to who have never received the vaccine under Part B; andA different, second pneumococcal vaccine one year after the first vaccines was administeredEffective dates of service on or after September 19, 2014 and does not require that a doctor of medicine or osteopathy order the vaccines.
14Scenario 166 year old patient with a cochlear implant. Previously received a PPSV23 at age 55. What pneumococcal vaccine (s) does this patient need?Today he would receive a dose of PVC13, since it has been a year from PPSV23. Then 6-12 months later he should receivePPSV23 since he hasn’t received the dose at 65 years of age
15Scenario 2A 20 year old asthma patient shows at your clinic, asking for a shot of that” new pneumonia shot” (PCV13). Does this patient need a PCV13 or a PPSV23 today?This patient meets the criteria for a PPSV year old with a chronic condition. When the client turns 65 he will receive a PCV13 (Prevnar 13) and a 6-12 months later the second PPSV23.