CDC modifies use of PCV13 recommendations for older adults

According to updated recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP), shared clinical decision making is recommended for PCV13 vaccination consideration in persons aged 65 years and older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13.

The update was announced in CDC’s Morbidity and Mortality Weekly Report (MMWR) on November 22.

Pneumococcal vaccination recommendations have undergone several changes in recent years, causing confusion for many health care providers. In 2014, ACIP recommended that older adults (ages 65 and older) receive PCV13 and pneumococcal polysaccharide vaccine (PPSV23).

In the new recommendation, ACIP said older adults should still receive a single dose of PPSV23. Shared clinical decision making between provider and patient is recommended for administration of PCV13. When patients and vaccine providers, including pharmacists, engage in shared clinical decision making to determine whether PCV13 is right for the specific individual aged 65 years and older, considerations may include the individual patient’s risk for exposure to PCV13 serotypes and the risk for pneumococcal disease for that person as a result of underlying medical conditions. If the patient does receive the vaccination, ACIP said it should be administered first, followed by PPSV23 at least 1 year later. 

Some groups of older adults are still vulnerable to pneumonia, including those who reside in areas with low childhood PCV13 uptake and could especially benefit from the PCV13 vaccination. In the report, ACIP said providers and practices caring for many patients in these groups may consider regularly offering PCV13 to their patients aged 65 years and older who have not previously received PCV13, including

  • Persons residing in nursing homes or other long-term-care facilities
  • Persons residing in settings with low pediatric PCV13 uptake
  • Persons traveling to settings with no pediatric PCV13 program

Incidence of PCV13-type invasive pneumococcal disease and pneumonia increases with age and is higher among persons with chronic heart, lung, or liver disease; diabetes; or alcoholism and in those who smoke cigarettes or who have more than one chronic medical condition, according to the report.

In its rationale for the recommended changes, ACIP said PCV13 use in children has led to sharp declines in pneumococcal disease among adults and children.

ACIP noted that the risk for PCV13-type disease among adults aged 65 years and older is much lower than it was before the pediatric program was implemented, as a result of indirect PCV13 effects. “The remaining risk is a function of each individual patient’s risk for exposure to PCV13 serotypes and the influence of underlying medical conditions on the patient’s risk for developing pneumococcal disease if exposure occurs,” said the report.

PCV13 is recommended for babies younger than age 2 years and is part of the routine vaccine series.