1. Update 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 #1003
CSF showing meningitis caused by S. pneumoniae

2. Objectives for Today Describe pneumococcal disease basics
Identify which adults need both PCV13 and PPSV23
Indentify which adults age need just PPSV23

3. Pneumococcal Disease
Second most common cause of vaccine preventable death in the US
Major clinical syndromes include
Pneumonia
Bacteremia
Meningitis
Streptococcus 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.[2]
It is better to prevent than to try and fight pneumococcal disease with antibiotics that might not work. .

4. 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

5. 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

6. 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
Purulence covering the brain surface
Photo courtesy of CDC

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

8. Adult 65 and Older
CDC recommends all adult ≥ 65 receive 2 types of pneumococcal vaccines
One 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 disease
Vaccine Naïve *PCV13 and PPSV23 cannot be given at the same visit - See more at:

9. Adult 19 to 64 Years Who Only Need PPSV23
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 PCV13

10. Adults 19 to 64 Who Should Receive both PCV13 and PPSV23*
Functional or anatomic asplenia†
Cochlear implants
Cerebrospinal 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

11. Age 65 Years or Older
This came from California Department of Public Health, Immunization Branch

12. Age 19-64 Years with Underlying Conditions
Prior doses count towards doses recommended in figure and do not need to be repeated
If 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

13. 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.

14. Scenario 1
66 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

15. Scenario 2
A 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.