Clinical Guidelines—PneumococcalVaccination in OlderAdults for the Preventionof PneumococcalDisease
BackgroundPneumococcal disease is• an invasive disease from  Streptococcus pneumoniae  (pneumococcus),• the leading cause ...
TransmissionPneumococcus is•found in many people’snoses and throats as atype of bacteria, and•spread by coughing,sneezing ...
Everybody Is at Risk                       4
Those at Greatest RiskAge Factors    The Very Young       ≥65 Adults                                      5
Those at Greatest RiskUnderlying Conditions        Long-Term Health                      Weakened Immune           Problem...
Those at Greatest RiskWeakened Respiratory Systems      Smokers            Asthma Sufferers                               ...
Clinical SyndromesPneumoccocus leads to serious infections of the                          covering of the brain          ...
Clinical SyndromesMortality Rates  Pneumonia       Bacteremia   Meningitis    1 in 20          1 in 5     3 in 10    death...
Clinical SyndromesMortality RatesThe highest mortality forbacteremia andmeningitis occurs amongthe elderly and patientswit...
Pneumonia•   Most common disease caused by pneumococcal    infection•   175,000 estimated U.S. cases annually•   Occurs al...
Pneumonia•   1–3 day incubation period•   5–7% fatality rate (may be much higher among    elderly)•   Accounts for 36% of ...
PneumoniaSymptoms            13
BacteremiaMore than 5,000 U.S. cases annually             Approximately 1 in 4 patients             with pneumonia develop...
BacteremiaSymptoms             15
Meningitis Accounts for 13–19% of all pneumococcal disease cases in the U.S.             Highest rate in children <1      ...
MeningitisSymptoms (Adults)                    17
Vaccination Approximately half of deaths from pneumococcal disease could be prevented by vaccinations.  50%               ...
PPSV23 VaccinePneumococcal   The 10 most    PPSV23 protectsdisease has    common         against 23more than 90   serotype...
PPSV23 VaccineEfficacyPPSV23 IS•60–70% effective against invasive disease,•very good at preventing severe disease,hospital...
PPSV23 VaccineEfficacyPPSV23 IS NOT•a “pneumonia vaccine,”•shown to provide protection against pneumococcalpneumonia, and•...
PPSV23 VaccineRecommendations             Adults 65 years and older            Anyone 2–64 years old with a long-term heal...
PPSV23 VaccineRecommendations       Anyone 2–64 years old with a disease or condition that       lowers the body’s resista...
PPSV23 VaccineRecommendationsOlder adults and persons with chronic illnesses orimmunodeficiency may not respond well, if a...
PPSV23 VaccineDosingOnly one dose is neededwith a few exceptions.                          25
PPSV23 VaccineDosing ExceptionsRevaccination is recommended for•People ≥65 years who got first dose younger than 65 and mo...
PPSV23 VaccineExclusionsAnyone•with a life-threatening allergic reaction to PPSV23•with a severe allergy to any component ...
PPSV23 VaccineRisks•   Mild side effects (redness or pain    at the injection site)•   Fever, muscle aches, or more    sev...
PPSV23 VaccineRisksPPSV23 cannot possibly cause pneumococcaldisease.It is an inactivated vaccine that contains only aporti...
PPSV23 VaccineMedicare CoverageC                    30
PPSV23 VaccineEndorsements       The Centers for Disease Control and Prevention       The Advisory Committee on Immunizati...
PPSV23 VaccinePocket GuideA laminated quick-reference tool from the CDC forfront-line healthcare personnel is available.Or...
ContactSandy Pogonesspogones@primaris.org314-374-6451                        33
ResourcesFrom the CDC:• Clinical Information on Pneumococcal• Updated Recommendations for the Prevention of Invasive Pneum...
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Pneumococcal Vaccination

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Pneumococcal Vaccination

  1. 1. Clinical Guidelines—PneumococcalVaccination in OlderAdults for the Preventionof PneumococcalDisease
  2. 2. BackgroundPneumococcal disease is• an invasive disease from Streptococcus pneumoniae (pneumococcus),• the leading cause of vaccine- preventable illness and death in the U.S., and• more dangerous to young children and the elderly (≥65). 2
  3. 3. TransmissionPneumococcus is•found in many people’snoses and throats as atype of bacteria, and•spread by coughing,sneezing or via contactwith respiratorysecretions. 3
  4. 4. Everybody Is at Risk 4
  5. 5. Those at Greatest RiskAge Factors The Very Young ≥65 Adults 5
  6. 6. Those at Greatest RiskUnderlying Conditions Long-Term Health Weakened Immune Problems SystemHeart or lung disease, sickle cell, Hodgkin’s lymphoma, leukemia, kidneydiabetes, alcoholism, cirrhosis, leaks failure, multiple myeloma, nephroticof cerebrospinal fluid, cochlear implant syndrome, HIV or AIDS, damaged or no spleen, organ transplant 6
  7. 7. Those at Greatest RiskWeakened Respiratory Systems Smokers Asthma Sufferers 7
  8. 8. Clinical SyndromesPneumoccocus leads to serious infections of the covering of the brain (meningitis) blood (bacteremia) lungs (pneumonia) 8
  9. 9. Clinical SyndromesMortality Rates Pneumonia Bacteremia Meningitis 1 in 20 1 in 5 3 in 10 deaths deaths deaths 9
  10. 10. Clinical SyndromesMortality RatesThe highest mortality forbacteremia andmeningitis occurs amongthe elderly and patientswith underlyingconditions. 10
  11. 11. Pneumonia• Most common disease caused by pneumococcal infection• 175,000 estimated U.S. cases annually• Occurs alone or in combination with bacteremia and/or meningitis• Not considered invasive but can be severe when isolated 11
  12. 12. Pneumonia• 1–3 day incubation period• 5–7% fatality rate (may be much higher among elderly)• Accounts for 36% of adult community-acquired pneumonia; 50% of hospital-acquired pneumonia 12
  13. 13. PneumoniaSymptoms 13
  14. 14. BacteremiaMore than 5,000 U.S. cases annually Approximately 1 in 4 patients with pneumonia develop bacteremia 20% overall case fatality May be as high as 60% among elderly 14
  15. 15. BacteremiaSymptoms 15
  16. 16. Meningitis Accounts for 13–19% of all pneumococcal disease cases in the U.S. Highest rate in children <1 year old As high as 80% elderly mortality rate 16
  17. 17. MeningitisSymptoms (Adults) 17
  18. 18. Vaccination Approximately half of deaths from pneumococcal disease could be prevented by vaccinations. 50% 18
  19. 19. PPSV23 VaccinePneumococcal The 10 most PPSV23 protectsdisease has common against 23more than 90 serotypes serotypes, includingserotypes. cause 62% of those most likely to invasive cause serious disease disease. worldwide. 19
  20. 20. PPSV23 VaccineEfficacyPPSV23 IS•60–70% effective against invasive disease,•very good at preventing severe disease,hospitalization and death, and•effective at developing antibodies within 2–3 weeks inmore than 80% of healthy adults. 20
  21. 21. PPSV23 VaccineEfficacyPPSV23 IS NOT•a “pneumonia vaccine,”•shown to provide protection against pneumococcalpneumonia, and•guaranteed to prevent infection and symptoms in allpeople. 21
  22. 22. PPSV23 VaccineRecommendations Adults 65 years and older Anyone 2–64 years old with a long-term health problem, heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of the cerebrospinal fluid or cochlear implant Updated recommendations for prevention of invasive pneumoccocal disease among adults using the PPSV23 vaccine. Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm 22
  23. 23. PPSV23 VaccineRecommendations Anyone 2–64 years old with a disease or condition that lowers the body’s resistance to infection Hodgkin’s lymphoma, leukemia, kidney failure, multiple myeloma, nephrotic syndrome, HIV infection or AIDS, damaged or no spleen, organ transplant Anyone 2–64 years old taking a drug or treatment that lowers the body’s resistance to infection long-term steroids, certain cancer drugs, radiation therapy Any adult 19–64 years old who is a smoker or has asthma 23
  24. 24. PPSV23 VaccineRecommendationsOlder adults and persons with chronic illnesses orimmunodeficiency may not respond well, if at all; however,it is still recommended because they are at high risk ofdeveloping severe disease. 24
  25. 25. PPSV23 VaccineDosingOnly one dose is neededwith a few exceptions. 25
  26. 26. PPSV23 VaccineDosing ExceptionsRevaccination is recommended for•People ≥65 years who got first dose younger than 65 and more than 5years have passed•People 2–64 years given first dose >5 years ago who have o a damaged or no spleen o nephrotic syndrome o sickle-cell disease o an organ or bone marrow transplant o HIV infection or AIDS o to take medication that lowers o cancer, leukemia, immunity (chemotherapy, long-term lymphoma, multiple steroids) myeloma 26
  27. 27. PPSV23 VaccineExclusionsAnyone•with a life-threatening allergic reaction to PPSV23•with a severe allergy to any component of the vaccine*•moderately to severely ill at time of administration•pregnant** or potentially pregnant* See CDC Pink Book in Resources at the end of this presentation for vaccine components.** No evidence exists that PPSV23 would be harmful to a pregnant woman or her fetus. 27
  28. 28. PPSV23 VaccineRisks• Mild side effects (redness or pain at the injection site)• Fever, muscle aches, or more severe local reactions in <1%• Rare serious reaction, as with all vaccines 28
  29. 29. PPSV23 VaccineRisksPPSV23 cannot possibly cause pneumococcaldisease.It is an inactivated vaccine that contains only aportion of the microbe. 29
  30. 30. PPSV23 VaccineMedicare CoverageC 30
  31. 31. PPSV23 VaccineEndorsements The Centers for Disease Control and Prevention The Advisory Committee on Immunization Practices The American Academy of Pediatrics The American College of Obstetricians and Gynecologists The American Academy of Family Physicians The American College of Physicians 31
  32. 32. PPSV23 VaccinePocket GuideA laminated quick-reference tool from the CDC forfront-line healthcare personnel is available.Order here: http://www.immunize.org/ppvguide/ 32
  33. 33. ContactSandy Pogonesspogones@primaris.org314-374-6451 33
  34. 34. ResourcesFrom the CDC:• Clinical Information on Pneumococcal• Updated Recommendations for the Prevention of Invasive Pneumoccal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23)• Pneumococcal Disease In-Short• PPSV23 What You Need to Know• Standing Orders for Administering Pneumococcal Vaccine to Adults• Pneumoccoccal Disease, Chapter 16 from the CDC Pink BookFrom the Immunization Action Coalition:• Ask the Experts• Vaccine Information 34
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