1. Pneumococcal Vaccination Small group cases:Facilitator’s Guide

2. Testing understanding
Which adults get PPSV23 alone?
Smokers, DM, Alcoholism, chronic heart disease, chronic lung disease (incl asthma), chronic liver disease
Which adults get PCV13 and PPSV23? How far apart?
Asplenia, HIV infection, cancer, renal failure, nephrotic syndrome, on immunosuppressants plus cochlear implants and CSF leak – 8 weeks apart

3. Testing understanding
What vaccines do all adults > 65 yrs get and in what order?
PCV13 then PPSV23, 12 months apart

4. Bonus questions Which patients get x3 doses of PPSV23?
Asplenic, HIV, cancer, renal failure, nephrotic syndrome, on immunosuppressants
How many doses of PCV13 are given to >18 year olds?
One only

5. Common Patient Scenarios
Scenario 1: A 65 year old female with no underlying medical conditions sees her doctor for a routine office visit. She has not previously received any pneumococcal vaccines.
Which vaccine(s) should you give?
Administer vaccines as follows:
1 dose of PCV13 now,
1 dose of PPSV23 at least 1 year later

6. Scenario 2: A 67 year old male sees his doctor for a routine office visit. He has no underlying conditions and received PPSV23 at age 65 years. Which vaccine(s) should you give?
Administer vaccines as follows:
1 dose of PCV13 as already had PPSV23 over one year ago

7. Scenario 3: A 65 year old female with diabetes sees her doctor for a routine office visit. She received PPSV23 at age 63 years. Which vaccine(s) should you give?
Administer vaccines as follows:
1 dose of PCV13 now followed by a dose of PPSV23 at age 68 years

8. Administer vaccines as follows: 1 dose of PPSV23 now, at age 24
Scenario 4: A 24 year old sees his doctor for a routine office visit. He has asthma and has not previously received any pneumococcal vaccines.
Administer vaccines as follows:
1 dose of PPSV23 now, at age 24
1 dose of PCV13 at age 65 followed by a dose of PPSV23 at least 1 year later
Note: Asthma is not an indication for adult administration of PCV13 unless the patient has received long-term systemic corticosteroids. This adult has an indication to receive a single dose of PPSV23 now. A dose of PCV13 would be given at age 65 years or older followed by a dose of PPSV23.

9. Scenario 5: A 28 year old woman with HIV infection received one dose of PPSV23 one year ago.
Administer vaccines as follows:
1 dose of PCV13 now because one year has passed since receipt of PPSV23
A second dose of PPSV23 at age 32 (if it’s been ≥5 years since previous PPSV23 and ≥8 weeks since PCV13 dose
A third dose of PPSV23 at age 65

10. Scenario 6: A 42 year old man with cochlear implants who has not previously received any pneumococcal vaccines.
Administer vaccines as follows:
1 dose of PCV13 now, at age 42
1 dose of PPSV23 at least 8 weeks after the dose of PCV13
A second dose of PPSV23 at age 65

11. Scenario 7: A 66 year old man with chronic heart disease who received a dose of PPSV23 at age 55.
Administer vaccines as follows:
1 dose of PCV13 now because age ≥65 and
at least one year has passed since receipt of PPSV23
1 dose of PPSV23 at least 1 year later
(and it’s been ≥5 years since previous PPSV23)