RISE: Raising Immunization RateS for Pneumococcal DiseasE in Adults

This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Recommended Immunization Schedule
for Adults Aged ≥19 Years by Age Group,
United States, 20171
HepA: hepatitis A vaccine; HepB: hepatitis B vaccine; Hib: Haemophilus influenzae type b conjugate vaccine; HPV: human papillomavirus vaccine; HZV: herpes zoster vaccine; MenACWY: serogroups A, C, W, and Y meningococcal conjugate vaccine; MenB: serogroup B
meningococcal vaccine; MMR: measles, mumps, and rubella vaccine; MPSV4: serogroups A, C, W, and Y meningococcal polysaccharide vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine; Td: tetanus and
diphtheria toxoids; Tdap: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; VAR: varicella vaccine.
1. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Accessed January 3, 2018.
PRACTICE AID
Access the activity,“RISE: Raising Immunization RateS for Pneumococcal DiseasE in Adults,”at
www.peerview.com/KHA40.
Vaccinea
19-21 Years 22-26 Years 27-59 Years 60-64 Years ≥65 Years
Influenza 1 dose annually
Td/Tdap Substitute Tdap for Td once, then Td booster every 10 years
MMR 1 or 2 doses depending on indication
VAR 2 doses
HZV 1 dose
HPV, female 3 doses
HPV, male
PCV13
PPSV23 1 or 2 doses depending on indication 1 dose
HepA 2 or 3 doses depending on vaccine
HepB 3 doses
MenACWY or MPSV4 1 or more doses depending on indication
MenB 2 or 3 doses depending on vaccine
Hib 1 or 3 doses depending on indication
3 doses
1 dose
Recommended for adults who meet the
age requirement, lack documentation of
vaccination, or lack evidence of past infection
a
Please visit the CDC website in the reference section for important general information and considerations for special populations.
Recommended for adults with additional
medical conditions or other indications
No recommendation

Recommended Immunization Schedule for
Adults Aged ≥19 Years by Medical Condition
and Other Indications, United States, 20171
ESRD: end-stage renal disease; HepA: hepatitis A vaccine; HepB: hepatitis B vaccine; Hib: Haemophilus influenzae type b conjugate vaccine; HPV: human papillomavirus vaccine; HZV: herpes zoster vaccine; MenACWY: serogroups A, C, W, and Y meningococcal conjugate vaccine;
MenB: serogroup B meningococcal vaccine; MMR: measles, mumps, and rubella vaccine; MPSV4: serogroups A, C, W, and Y meningococcal polysaccharide vaccine; MSM: men who have sex with men; PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent
pneumococcal polysaccharide vaccine; Td: tetanus and diphtheria toxoids; Tdap: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; VAR: varicella vaccine.
1. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Accessed January 3, 2018.
PRACTICE AID
Vaccinea
Pregnancy
Immuno-
compromised
(Excluding HIV
Infection)
HIV Infection
CD4+ Count
(cells/μL)
Asplenia,
Persistent
Complement
Deficiencies
Kidney Failure,
ESRD, on
Hemodialysis
Heart or Lung
Disease, Chronic
Alcoholism
Chronic Liver
Disease
Diabetes
Healthcare
Personnel
MSM
<200 ≥200
Influenza 1 dose annually
Td/Tdap
1 dose
Tdap each
pregnancy
Substitute Tdap for Td once, then Td booster every 10 years
MMR Contraindicated 1 or 2 doses depending on indication
VAR Contraindicated 2 doses
HZV Contraindicated 1 dose
HPV, female Three doses 3 doses through age 26 years
HPV, male 3 doses through age 26 years 3 doses through age 21 years
3 doses through
age 26 years
PCV13
PPSV23
HepA
HepB
MenACWY
or MPSV4
MenB
Hib
3 doses post-HSCT
recipients only
1 dose
1, 2, or 3 doses depending on indication
2 or 3 doses depending on vaccine
1 dose
3 doses
1 or more doses depending on indication
2 or 3 doses depending on vaccine
Recommended for adults who meet the age requirement,
lack documentation of vaccination, or lack evidence of
past infection
Recommended for adults with additional
medical conditions or other indications
No recommendationContraindicated
a
Please visit the CDC website in the reference section for important general information and considerations for special populations.

Information for Adult Patients
2017 Recommended Immunizations for Adults:
By Age1
MenACWY: serogroups A, C, W, and Y meningococcal conjugate vaccine; MenB: serogroup B meningococcal vaccine; MPSV4: meningococcal polysaccharide vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.
1. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-easy-read.pdf. Accessed January 3, 2018.
PRACTICE AID
May be recommended for you: This vaccine
is recommended for you if you have certain risk
factors due to your health condition or other.
Talk to your healthcare professional to see if
you need this vaccine
Recommended for you: This vaccine is
recommended for you unless your healthcare
professional tells you that you do not need it or
should not get it.
Flu
Influenza
Td/Tdap
Tetanus,
diphtheria,
pertussis
Shingles
Zoster
Pneumococcal Meningococcal MMR
Measles,
mumps,
rubella
HPV
Human papillomavirus
Chickenpox
Varicella
Hepatitis
A
Hepatitis B
Hib
Haemophilus
influenzae
type bPCV13 PPSV23
MenACWY
or MPSV4
MenB Women Men
19-21 years
22-26 years
27-59 years
60-64 years
65+ years
You should
get flu
vaccine
every
year.
You should
get a Td
booster every
10 years. You
also need
one dose of
Tdap. Women
should get a
Tdap vaccine
during every
pregnancy to
help protect
the baby.
You should
get shingles
vaccine
even if you
have had
shingles
before.
You should get one dose
of PCV13 and at least one
dose of PPSV23 depending
on your age and health
condition.
You should get this vaccine if you did not get it when you were a child.
talk to your healthcare professional about these vaccines
You should get HPV
vaccine if you are a woman
through age 26 years or
a man through age 21
years and did not already
complete the series.
If you are
this age,
More
information
If you are traveling outside the United States, you may need additional vaccines.
Ask your healthcare professional about which vaccines you may need
at least 6 weeks before you travel.

Information for Adult Patients
2017 Recommended Immunizations for Adults:
By Health Condition1
CD: cluster of differentiation; MenACWY: serogroups A, C, W, and Y meningococcal conjugate vaccine; MenB: serogroup B meningococcal vaccine; MPSV4: meningococcal polysaccharide vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent
pneumococcal polysaccharide vaccine.
1. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-easy-read.pdf. Accessed January 3, 2018.
PRACTICE AID
Access the activity,“RISE: Raising Immunization RateS for Pneumococcal DiseasE in Adults,”at www.peerview.com/KHA40.
May be recommended for you: This vaccine
is recommended for you if you have
certain risk factors due to your age, health
condition, or other. Talk to your healthcare
professional to see if you need this vaccine.
YOU SHOULD NOT GET
THIS VACCINE.
Recommended for you: This vaccine is
recommended for you unless your
healthcare professional tells you that
you do not need it or should not get it.
Flu
Influenza
Td/Tdap
Tetanus,
diphtheria,
pertussis
Shingles
Zoster
Pneumococcal Meningococcal MMR
Measles,
mumps,
rubella
HPV
Human papillomavirus
Chickenpox
Varicella
Hepatitis A Hepatitis B
Hib
Haemophilus
influenzae
type bPCV13 PPSV23
MenACWY
or MPSV4
MenB Women Men
Pregnancy
Weakened immune
system
HIV: CD4 count
<200
HIV: CD4 count
≥200
Kidney disease or poor
kidney function
Asplenia (if you do not
have a spleen or if it does
not work well)
Heart disease
Lung disease
Chronic alcoholism
Diabetes
(type 1 or type 2)
Chronic liver disease
You should
get flu
vaccine
every
year.
You should
get a Td
booster every
10 years. You
also need
one dose of
Tdap vaccine.
Women
should get
Tdap vaccine
during every
pregnancy.
You should
get shingles
vaccine if
you are
aged
60 years or
older, even
if you have
had
shingles
before.
You should get
Hib vaccine if
you do not
have a spleen,
have sickle cell
disease,
or received a
bone marrow
transplant.
You should get one dose of
PCV13 and at least one dose of
PPSV23 depending on your age
and health condition.
You should get this vaccine if you did not get it when you were a child.
You should get HPV
vaccine if you are a woman
through age 26 years or
a man through age 21
years and did not already
complete the series.
If you have this
health condition,
More
information
talk to your healthcare professional about these vaccines

Vaccine Information Statement
Pneumococcal Conjugate Vaccine (PCV13)
What You Need to Know1
PRACTICE AID
1. Why get
vaccinated?
2. PCV13
vaccine
3. Some people
should not get
this vaccine
4. Risks of
vaccine
reaction
Vaccination can protect both children and adults from pneumococcal disease.
Pneumococcal disease is caused by bacteria that can spread from person to person through close contact. It can
cause ear infections, and it can also lead to more serious infections of the
• Lungs (pneumonia)
• Blood (bacteremia)
• Covering of the brain and spinal cord (meningitis)
Pneumococcal pneumonia is most common among adults. Pneumococcal meningitis can cause deafness and brain
damage, and it kills about 1 child in 10 who get it.
Anyone can get pneumococcal disease, but children under 2 years of age and adults 65 years and older, people with
certain medical conditions, and cigarette smokers are at the highest risk.
Before there was a vaccine, the United States saw the following in children under 5 each year from pneumococcal
disease:
• More than 700 cases of meningitis
• About 13,000 blood infections
• About 5 million ear infections
• About 200 deaths
Since a vaccine became available, severe pneumococcal disease in these children has fallen by 88%.
About 18,000 older adults die of pneumococcal disease each year in the United States.
Treatment of pneumococcal infections with penicillin and other drugs is not as effective as it used to be, because
some strains of the disease have become resistant to these drugs. This makes prevention of the disease, through
vaccination, even more important.
Pneumococcal conjugate vaccine (called PCV13) protects against 13 types of pneumococcal bacteria.
PCV13 is routinely given to children at 2, 4, 6, and 12–15 months of age. It is also recommended for children and
adults 2 to 64 years of age with certain health conditions, and for all adults 65 years of age and older. Your doctor can
give you details.
Anyone who has ever had a life-threatening allergic reaction to a dose of this vaccine, to an earlier pneumococcal
vaccine called PCV7, or to any vaccine containing diphtheria toxoid (for example, DTaP), should not get PCV13.
Anyone with a severe allergy to any component of PCV13 should not get the vaccine. Tell your doctor if the person
being vaccinated has any severe allergies.
If the person scheduled for vaccination is not feeling well, your healthcare provider might decide to reschedule the
shot on another day.
With any medicine, including vaccines, there is a chance of reactions. These are usually mild and go away on their
own, but serious reactions are also possible.
Problems reported following PCV13 varied by age and dose in the series. The most common problems reported
among children were
• About half became drowsy after the shot, had a temporary loss of appetite, or had redness or tenderness where
the shot was given
• About 1 out of 3 had swelling where the shot was given
• About 1 out of 3 had a mild fever, and about 1 in 20 had a fever over 102.2°F
• Up to about 8 out of 10 became fussy or irritable
Adults have reported pain, redness, and swelling where the shot was given; also mild fever, fatigue, headache, chills,
or muscle pain.
Young children who get PCV13 along with inactivated flu vaccine at the same time may be at increased risk for
seizures caused by fever. Ask your doctor for more information.

Pneumococcal Conjugate Vaccine (PCV13)
PRACTICE AID
1. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/pcv13.pdf. Accessed January 3, 2018.
5. What if there
is a serious
reaction?
6. The National
Vaccine Injury
Compensation
Program
7. How can I
learn more?
Problems that could happen after any vaccine
• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15
minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision
changes or ringing in the ears.
• Some older children and adults get severe pain in the shoulder and have difficulty moving the arm where a shot
was given. This happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at
about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination. As with
any medicine, there is a very small chance of a vaccine causing a serious injury or death. The safety of vaccines is
always being monitored. For more information, visit: www.cdc.gov/vaccinesafety/.
What should I look for?
Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or unusual behavior.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast
heartbeat, dizziness, and weakness—usually within a few minutes to a few hours after the vaccination.
What should I do?
If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the nearest
hospital. Otherwise, call your doctor.
Reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor should file this
report, or you can do it yourself through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not give medical advice.
The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate
people who may have been injured by certain vaccines.
Persons who believe they may have been injured by a vaccine can learn about the program and about filing a claim by
calling 1-800-338-2382 or visiting the VICP website at www.hrsa.gov/vaccinecompensation. There is a time limit
to file a claim for compensation.
• Ask your healthcare provider. He or she can give you the vaccine package insert or suggest other sources of
information.
• Call your local or state health department.
• Contact the Centers for Disease Control and Prevention (CDC)
-- Call 1-800-232-4636 (1-800-CDC-INFO)
-- Visit CDC’s website at www.cdc.gov/vaccines

Pneumococcal Polysaccharide Vaccine
PRACTICE AID
1. Why get
vaccinated?
2. Pneumococcal
polysaccharide
vaccine
(PPSV23)
3. Some people
should not get
this vaccine
Vaccination can protect older adults (and some children and younger adults) from pneumococcal disease.
Pneumococcal disease is caused by bacteria that can spread from person to person through close contact. It can
cause ear infections, and it can also lead to more serious infections of the
• Lungs (pneumonia)
• Blood (bacteremia)
• Covering of the brain and spinal cord (meningitis); meningitis can cause deafness and brain damage, and it can
be fatal.
Anyone can get pneumococcal disease, but children under 2 years of age, people with certain medical conditions,
adults over 65 years of age, and cigarette smokers are at the highest risk.
About 18,000 older adults die each year from pneumococcal disease in the United States.
Treatment of pneumococcal infections with penicillin and other drugs used to be more effective. But some strains
of the disease have become resistant to these drugs. This makes prevention of the disease, through vaccination,
even more important.
Pneumococcal polysaccharide vaccine (PPSV23) protects against 23 types of pneumococcal bacteria. It will not
prevent all pneumococcal disease.
PPSV23 is recommended for
• All adults 65 years of age and older
• Anyone 2 through 64 years of age with certain long-term health problems
• Anyone 2 through 64 years of age with a weakened immune system
• Adults 19 through 64 years of age who smoke cigarettes or have asthma
Most people need only one dose of PPSV. A second dose is recommended for certain high-risk groups. People 65
and older should get a dose even if they have gotten one or more doses of the vaccine before they turned 65.
Your healthcare provider can give you more information about these recommendations.
Most healthy adults develop protection within 2 to 3 weeks of getting the shot.
• Anyone who has had a life-threatening allergic reaction to PPSV should not get another dose.
• Anyone who has a severe allergy to any component of PPSV should not receive it. Tell your provider if you have
any severe allergies.
• Anyone who is moderately or severely ill when the shot is scheduled may be asked to wait until they recover
before getting the vaccine. Someone with a mild illness can usually be vaccinated.
• Children less than 2 years of age should not receive this vaccine.
• There is no evidence that PPSV is harmful to either a pregnant woman or to her fetus. However, as a precaution,
women who need the vaccine should be vaccinated before becoming pregnant, if possible.

Pneumococcal Polysaccharide Vaccine
PRACTICE AID
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.pdf. Accessed January 3, 2018.
4. Risks of
vaccine reaction
5. What if there
is a serious
reaction?
6. How can I
learn more?
With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on
their own, but serious reactions are also possible.
About half of people who get PPSV have mild side effects, such as redness or pain where the shot is given, which
go away within about two days.
Less than 1 out of 100 people develop a fever, muscle aches, or more severe local reactions.
Problems that could happen after any vaccine
• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15
minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision
changes or ringing in the ears.
• Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This
happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at
about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.
As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.
The safety of vaccines is always being monitored. For more information, visit: www.cdc.gov/vaccinesafety/
What should I look for?
Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or unusual
behavior.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast
heartbeat, dizziness, and weakness. These would usually start a few minutes to a few hours after the vaccination.
What should I do?
If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the
nearest hospital. Otherwise, call your doctor.
Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor
might file this report, or you can do it yourself through the VAERS website at www.vaers.hhs.gov, or by calling
1-800-822-7967.
VAERS does not give medical advice.
• Ask your healthcare provider. He or she can give you the vaccine package insert or suggest other sources
of information.
• Call your local or state health department.
• Contact the Centers for Disease Control and Prevention (CDC)
-- Call 1-800-232-4636 (1-800-CDC-INFO)
-- Visit CDC’s website at www.cdc.gov/vaccines

Standards for Adult
Immunization Practice1
PRACTICE AID
1. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html. Accessed January 17, 2018.
1. ASSESS immunization status of all your patients at every clinical encounter.
• Stay informed. Get the latest CDC recommendations for immunization of adults.
• Implement protocols and policies. Ensure that patients’ vaccine needs are routinely
reviewed and patients get reminders about vaccines they need.
2. Strongly RECOMMEND vaccines that patients need.
• Share tailored reasons why vaccination is right for the patient.
• Highlight positive experiences with vaccination.
• Address patient questions and concerns.
• Remind patients that vaccines protect them and their loved ones against a number of
common and serious diseases.
• Explain the potential costs of getting sick.
3. ADMINISTER needed vaccines or REFER your patients to a vaccination provider.
• Offer the vaccines you stock.
• Refer patients to providers in the area that offer vaccines that you don’t stock.
4. DOCUMENT vaccines received by your patients.
• Participate in your state’s immunization registry. Help your office, your patients, and
your patients’ other providers know which vaccines your patients have had.
• Follow up. Confirm that patients received recommended vaccines that you referred them to
get from other immunization providers.

Adult Pneumococcal Vaccination
Guide for HCPs1,2
PRACTICE AID
Two types of pneumococcal vaccine are recommended for use in US adults: a 13-valent pneumococcal conjugate vaccine (PCV13) and a 23-valent
pneumococcal polysaccharide vaccine (PPSV23). Recommendations for their use vary by age and risk factors. Every adult aged 65 years and older
should receive both PCV13 and PPSV23. The table below will aid in determining which adults aged 19 to 64 years need pneumococcal vaccination.
Details on sequence and timing of doses for adults in both age groups can be found on page 2 of this practice aid. Additional information and clinical
guidance regarding the use of PCV13 and PPSV23 can be found at: cdc.gov/vaccines/vpd-vac/pneumo/
Indications for PCV13 and PPSV23 Administration for Adults Aged 19 to 64 Years by Risk Group
Risk Group
Underlying Medical
Conditions
PCV13 PPSV23
Recommended Recommended
Revaccination 5 Years
After First Dose
Immunocompromised
personsa
Congenital or acquired
immunodeficiencyb ü ü ü
HIV ü ü ü
Chronic renal failure ü ü ü
Nephrotic syndrome ü ü ü
Leukemia ü ü ü
Lymphoma ü ü ü
Hodgkin disease ü ü ü
Generalized malignancy ü ü ü
Iatrogenic immunosuppressionc
ü ü ü
Solid organ transplant ü ü ü
Multiple myeloma ü ü ü
Persons with functional
or anatomic aspleniaa
Sickle cell disease/other
hemoglobinopathy
ü ü ü
Congenital or acquired asplenia ü ü ü
Immunocompetent
personsa
Cerebrospinal fluid leak ü ü
Cochlear implant ü ü
Immunocompetent
persons
Chronic heart diseased
ü
Chronic lung diseasee
ü
Diabetes mellitus ü
Alcoholism ü
Chronic liver disease, cirrhosis ü
Cigarette smoking ü
a
See Figure 1 for timing of these doses.
b
Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders
(excluding chronic granulomatous disease).
c
Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy.
d
Including congestive heart failure and cardiomyopathies, excluding hypertension.
e
Including chronic obstructive pulmonary disease, emphysema, and asthma.

Adult Pneumococcal Vaccination
Guide for HCPs1,2
PRACTICE AID
C1: complement component 1; C2: complement component 2; C3: complement component 3; C4: complement component 4; CSF: cerebrospinal fluid; HCPs: healthcare providers;
PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.
1. http://www.adultvaccination.org/professional-resources/pneumo/adult-pneumo-guide-hcp.pdf. Accessed January 3, 2018. 2. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/
pneumo.html. Accessed January 3, 2018.
People aged 19 to 64 years with chronic heart, lung or liver disease, diabetes, alcoholism, cirrhosis, or who are
cigarette smokers need one dose of PPSV23.
The charts below provide details on timing of PCV13 and PPSV23 doses for all others.
Figure 1. PCV13 and PPSV23 Timing for US Adults Aged
19 to 64 Years With Immunocompromising Conditions,
Functional Asplenia, CSF Leaks, or Cochlear Implantsa
Pneumococcal Vaccine-Naïve Persons
Persons Previously Vaccinated With PPSV23
a
See Table on page 1 for details on which adults aged 19 to 64 years need
pneumococcal vaccination.
b
This dose not indicated for adults with CSF leaks or cochlear implants.
Figure 2. PCV13 and PPSV23 Timing for US Adults Aged
65 Years or Older
Pneumococcal Vaccine-Naïve Persons
Persons Who Previously Received PPSV23 at ≥65 Years
Persons Who Previously Received PPSV23 Before Age
65 Years Because They Have a Risk Factor
Pneumococcal vaccines given at intervals <1 year do not need
to be repeated.
Additional Facts About Pneumococcal Vaccination
• Mild side effects include redness or pain at the injection site. In rare cases fever, muscle aches, or more severe injection-site
reactions may develop.
• Vaccination can be administered any time of year, and one pneumococcal vaccine can be given at the same time as
influenza vaccine.
Note: Medicare will reimburse for two pneumococcal vaccines
as long as they are given at least 11 months apart.
≥8 weeks ≥5 years
and PPSV23 at
65 years or older
PCV13 PPSV23 PPSV23b
≥5 years
≥1 year ≥8 weeks
and PPSV23 at
65 years or older
PCV13 PPSV23 PPSV23b
≥1 year ≥1 year
≥5 years
PPSV23 at
age ≤65 years
PPSV23PCV13 at
age ≥65 years
PPSV23 at
age ≥65 years
≥1 year
PCV13
PCV13 at
age ≥65 years
≥1 year
PPSV23

Adult Vaccination Reminder Email1
PRACTICE AID
1. http://www.adultvaccination.org/professional-resources/adult/reminder-email.docx. Accessed January 4, 2018.
Suggested Subject Line: Adults Need Vaccines Too
Dear [PATIENT NAME],

Vaccines aren’t only for kids; adults need them too. Vaccine-preventable diseases kill more US adults each year than HIV/AIDS,
breast cancer, or traffic accidents.
We encourage all of our adult patients to get their vaccines. There are good reasons to make sure you are vaccinated:
• Seasonal influenza vaccine for all adults, every year
– The flu is not just a runny nose and a case of the sniffles. People of all ages can die from influenza. Even an average
case can put you in bed for weeks.
• Tdap vaccine (tetanus, diphtheria, and pertussis) for all adults who have never received it
– This vaccine helps prevent pertussis, or whooping cough, which can make adults very sick but can be fatal if you
pass it on to a baby. You can help protect infants in your family and our community by getting this vaccine.
Pregnant women should receive a Tdap vaccine with every pregnancy.
[OPTIONAL: There has been an increase of whooping cough cases in our community this year, making this vaccine extremely
important.]
• Pneumococcal vaccine for adults age 65 and older, younger adults with certain health conditions, and
cigarette smokers
– Pneumococcal disease causes pneumonia, bloodstream infection, and meningitis. In the United States, it kills tens
of thousands each year, including 18,000 adults age 65 years and older.
• Shingles vaccine for all adults age 60 and older
– About one million people in the United States get shingles every year. Shingles pain may last for weeks, months,
or even years.
• Hepatitis B vaccine for adults at risk and those with certain health conditions, including all adults age 19 through
59 years with diabetes
– There is no treatment for hepatitis B virus. It is a silent disease that many people don’t know they have until they
develop complications like liver cancer or cirrhosis. In the United States, an estimated 2.2 million people are
chronically infected with the hepatitis B virus.

• HPV vaccine for women through age 26; all men through age 21 and some men through age 26 with certain health
conditions or lifestyle factors, if not previously immunized
– HPV causes cervical, vulvar, and vaginal cancers in females; penile cancer in males; and anal, throat, and other oral
cancers in both sexes.
If you are not sure about your vaccination history and status, please call us today. We want all of our patients to be protected.
For more information, visit adultvaccination.org.
Sincerely,

[INSERT NAME]
[INSERT OFFICE CONTACT INFORMATION]

Immunization Assessment Tool:
Risk for Pneumococcal Disease1
PRACTICE AID
HCPs: healthcare providers.
1. http://www.adultvaccination.org/professional-resources/pneumo/assessment-tool-inoffice.pdf. Accessed January 3, 2018.
Pneumococcal disease is a very serious infection that causes pneumonia, meningitis, and bloodstream infection. There are
vaccines that greatly reduce your chance of getting it. To determine whether you may need pneumococcal vaccination,
please check all that apply below. Even if you already had one vaccination, you may need another.
Check all that apply ü Yes
Are you 65 years or older?
Do you have any of these diseases or medical conditions?
Alcoholism
Asthma
Blood disorder (eg, anemia, leukemia, sickle cell anemia, etc)
Cancer
Cerebrospinal fluid (CSF) leaks
Cochlear implants
Diabetes
Heart disease
HIV/AIDS
Immunodeficiency
Kidney disease
Liver disease
Lung disease
Solid organ transplant
Spleen damaged, inactive, or surgically absent
Do you smoke cigarettes?
Do you live or work at a long-term residential facility such as a nursing home?
Have you ever received a pneumococcal vaccination or a “pneumonia shot” in the past?
If you checked any of the boxes above, your doctor may recommend that you be vaccinated against pneumococcal disease.
All adults should also receive an annual influenza vaccine to reduce risk of both flu and pneumococcal disease. Any adult
who has never received a Tdap (tetanus, diphtheria, and pertussis or “whooping cough”) vaccine should get one.
If you are age 60 or older, have other chronic health conditions, or are age 26 or younger, you may need additional
vaccinations. For more information, visit adultvaccination.org. Note for healthcare professionals: For more information,
please refer to the Adult Pneumococcal Vaccination Guide for HCPs or visit cdc.gov/vaccines/vpd-vac/pneumo.

Patient Education:
Pneumococcal Infographic1
PRACTICE AID
1. www.adultvaccination.org/pneumococcal-infographic. Accessed January 4, 2018.
What do they all have in common?
They are all at increased risk for an infection called pneumococcal disease.
Getting vaccinated is the safest, most effective way to protect yourself.
Nearly one million people get pneumococcal pneumonia
in the United States every year and 5% to 7% of them die.
Everyone 65 years and older and all adults with certain health conditions are at risk.
Learn more at adultvaccination.org/pneumococcal
• Pneumococcal disease can cause pneumonia, meningitis,
or bloodstream infection (sepsis), which can lead to severe
complications, hospitalizations, or death
Ask your healthcare provider about pneumococcal vaccination today.
Medicare and most private insurers cover the cost of vaccination for those who need it.
PharmacyMedical office
Miguel, age 55
Diabetes
Diane, age 50
Heart disease
Bill, age 28
Smoker
David, age 30
Asthma
Lily, age 65
Patricia, age 41
Lymphoma
Carl, age 37
HIV
Pneumococcal meningitis and bloodstream infection are less common, but more deadly.
One in every four to five people over the age of 65 who get it will die.

Addressing Common Questions
about Pneumococcal Vaccination
for Adults1
PRACTICE AID
What diseases do these vaccines protect against?
There are two vaccines that protect against pneumococcal disease,
which is caused by infection with a common bacterium called
Streptococcus pneumoniae.
• PCV13 (pneumococcal conjugate vaccine) protects against
13 of the approximately 90 types of pneumococcal bacteria
that can cause the most serious types of pneumococcal disease,
including pneumonia, meningitis, and bacteremia.
• PPSV23 (pneumococcal polysaccharide vaccine) protects
against 23 types of pneumococcal bacteria. This vaccine helps
prevent invasive infections like meningitis and bacteremia.
How common is pneumococcal disease?
Each year in the United States, pneumococcal disease kills
thousands of adults, including 18,000 adults 65 years or older.
Thousands more end up in the hospital because of pneumococcal
disease.
How does pneumococcal disease spread?
Pneumococcal bacteria can spread from person to person by
direct contact with respiratory secretions, like saliva or mucus.
People can carry the bacteria in their nose and throat, and can
spread the bacteria without feeling sick.
Who is at risk for pneumococcal disease?
• People 65 years and older
• People with certain health conditions, such as chronic lung
disease or diabetes
• People with conditions that lower the body’s resistance to
infection (weakened immune system)
• People who smoke cigarettes
What could happen if I get this disease?
Pneumococcal disease ranges from mild to
very dangerous. Pneumococcal disease can
spread from the nose and throat to ears or
sinuses, causing generally mild infections,
or spread to other parts of the body, leading
to severe health problems such as lung
infections (pneumonia), blood infections
(bacteremia), and infection of the covering
around the brain and spinal cord (meningitis).
These serious illnesses can lead to disabilities
like deafness, brain damage, or loss of
arms or legs. These illnesses can also be life
threatening.
• Pneumococcal pneumonia kills about 1 out
of 20 people who get it
• Pneumococcal bacteremia kills about 1 out
• Pneumococcal meningitis kills about 1 out
Adults with chronic conditions are at
increased risk of developing complications
from pneumococcal disease.

Addressing Common Questions
about Pneumococcal Vaccination
for Adults1
PRACTICE AID
1. https://www.cdc.gov/vaccines/hcp/adults/downloads/fs-pneumo-hcp.pdf. Accessed January 4, 2018.
Who should get these vaccines?
When and how often are they needed?
PCV13: Adults should get one dose of this vaccine before starting or continuing
doses of PPSV23. It is recommended for
• All adults 65 years or older
• Adults 19 years or older with certain medical conditions
PPSV23: Adults should get one, two, or three doses of this vaccine, depending
on their age, health condition, and timing of the first dose. It is recommended for
• All adults 65 years or older
• Adults 19 years or older with certain health conditions
• Adults 19 years or older who smoke cigarettes
Who should not get these vaccines?
PCV13: Anyone who has ever had a life-threatening
allergic reaction to a dose of the vaccine, to an
earlier pneumococcal vaccine called PCV7 (or
Prevnar), or to any vaccine containing diphtheria
toxoid (for example, DTaP), should not get PCV13.
Anyone with a severe allergy to any component of
PCV13 should not get the vaccine.
PPSV23: Anyone who has ever had a life-
threatening allergic reaction to a dose of the
vaccine or with a severe allergy to any component
of the vaccine should not get the vaccine.
How well do the vaccines work?
PCV13: Studies done on PCV13 use in adults showed the vaccine to be 75% effective in preventing invasive pneumococcal disease, like
bloodstream infections and meningitis, and 45% effective at preventing non-invasive pneumonia caused by the 13 strains it covers.
PPSV23: In adults with healthy immune systems, this vaccine has been shown to be 50%-85% effective in preventing invasive disease
caused by the 23 strains it covers.
How safe are these vaccines?
Pneumococcal vaccines are very safe. They went through years of testing before being licensed by the FDA and continue to be
monitored for safety by the FDA and CDC.
Is it safe to get if I have certain health conditions or am taking prescription meds?
Unless you have had an allergic reaction in the past to the vaccine or have allergies to certain components of the vaccine, it
is safe to get. It is safe for people taking prescription medications to get vaccines.
What are the potential side effects of these vaccines?
PCV13: Adults receiving the vaccine have reported redness, pain, and swelling where the shot was given. Mild fever, fatigue, headache,
chills, or muscle pain have also been reported. Life-threatening allergic reactions from this vaccine are very rare.
PPSV23: About half of people who get PPSV23 have mild side effects, such as redness or pain where the shot is given. Less than 1%
develop a fever, muscle aches, or more severe local reactions. The risk of a vaccine causing serious reaction, or death, is extremely small.
Where can I get these vaccines?
Pneumococcal vaccines may be available at private doctor offices, public or
community health clinics, pharmacies, or other community locations (such
as schools/universities, workplaces, religious centers or places of worship).
Check with your doctor or pharmacist or use the Adult Vaccine Finder
(vaccine.healthmap.org) to help find places that provide pneumococcal
vaccines near you.
How much do the vaccines cost?
Most private health insurance covers pneumococcal
vaccines. Check with your insurance provider for
details on whether there is any cost to you and for a
list of in-network vaccine providers. Medicare Part B
covers the cost of both pneumococcal vaccines (when
administered at least 12 months apart).

Six STEPS for Implementing a
Team-Based Immunization Program1
PRACTICE AID
PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.
1. https://www.stepsforward.org/modules/adult-vaccinations. Accessed January 4, 2018.
1. Get your team on board.
• Your recommendation is the single most important factor in influencing a person’s decision to get
vaccinated; therefore, it is vital that you convey strong support for vaccination not only to your patients but
also to your team members.
2. Train your team.
• Training for your practice/organization can focus on topics such as
– Vaccine fundamentals
– Communicating benefits and risks of vaccines
– Preparation, administration, and adverse event reporting
– Storage and handling
– Billing, coding, and documentation (includes standing orders)
3. Prepare your team to address common patient questions.
• All team members, from medical assistants to nurses, should feel comfortable telling patients that vaccines
are safe, necessary, and effective, remembering that anecdotes resonate stronger than data.
– Provide short stories of patients who have had a vaccine-preventable illness and emphasize that the
most common side effect of vaccination is a sore arm.
4. Implement a standardized process.
• Identify which patients are due for which vaccines for the next day's clinic.
– Many electronic medical record (EMR) systems have age- and disease-specific reminders for
immunizations that are due, and using these can save a lot of time.
• Have front desk staff prepare and hand patients a preprinted vaccine information statement (VIS) when
they check in.
• Use standing order sets for vaccine administration before the physician component of the appointment
and for documentation.
– These can standardize and streamline practice and may be particularly useful when dealing with
vaccines with complicated schedules (eg, the pneumococcal vaccines PPSV23 and PCV13).
• If your patient declines a vaccination, ask why and then provide further counseling and encouragement.
• Use standard protocols for managing and reporting adverse events from vaccinations.
5. Document vaccines given, and minimize financial risk.
• Minimizing the risk for financial losses starts with reducing wasted vaccines.
6. Recognize and reward the participation of your team.
• When starting your immunization program, debrief with your team regularly to identify unexpected
challenges and troubleshoot how to overcome them.

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