ACIP votes to recommend PCV13 for adults aged 65 years and older

ACIP holds interim meeting August 13

An interim Advisory Committee on Immunization Practices (ACIP) meeting was held via Web/telephone conference on August 13, 2014, to discuss the use of pneumococcal conjugate vaccine (PCV13) (Prevnar 13—Pfizer) in adults. This was delayed from the June ACIP meeting because more information needed to be gathered. It was felt this meeting should be held before the upcoming respiratory season to decide the potential use of PCV13 vaccine in adults.

The pneumococcal working group proposed that PCV13, in addition to pneumococcal polysaccharide vaccine (PPSV23) (Pneumovax—Merck), should be administered to all adults aged 65 years and older.

The CAPITA trial results were presented at the June ACIP meeting. Recent data demonstrated a 75% reduction in vaccine-type invasive pneumococcal disease (IPD) and 45% reduction in vaccine-type nonbacteremic pneumonia (NBP). Disease is estimated at 2,600 PCV13-type IPD cases and more than 50,000 PCV13-type inpatient community acquired pneumonia (CAP). The workgroup also estimated a vaccine efficacy of 45% for PPSV23 against NBP. Based upon this new analysis, the impact of adding PCV13 to PPSV23 was estimated to reduce outpatient NBP by 2,261 cases, IPD deaths by 33, and deaths due to NBP by 104.

The available data on the interval between vaccination of PCV13 and PPSV23 were discussed during the ACIP meeting, with the recommendation for PCV13 use in immunocompromised patients.

The indirect effects (herd effects) of PCV13 on children since its introduction in 2010 are decreasing IPD caused by vaccine-type serotypes and will decrease the need for PCV13 in the near future. The working group estimated there would be a decrease of CAP by 2019 by 86% due to this effect. They suggest that this recommendation should be re-evaluated in 2018. 

The working group’s proposed recommendation was: Adults aged 65 years and older who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. A dose of PPSV23 should be given 6 to 12 months following a dose of PCV13. If PPSV23 cannot be given during this time window, a dose of PPSV23 should be given during the next visit. The two vaccines should not be coadministered.  Adults aged 65 years and older who have not previously received PCV13 and who have previously received one or more doses of PPSV23 should receive a dose of PCV13 at least 12 months following the PCV23.

CMS would not likely be able to cover two pneumococcal vaccines during this upcoming season. It takes about 1 year to make a policy change based upon legal requirements, including public comment. Two vaccines would not be paid for by CMS, if given this year, because only one pneumococcal vaccine (type not specified) is already covered.

The committee voted 13–2 to approve this recommendation for the use of PCV13 in adults aged 65 years and older.