This document provides clinical guidelines for pneumococcal vaccination in older adults. It describes pneumococcal disease as a leading cause of vaccine-preventable illness and death in the US, especially dangerous for young children and adults aged 65 and older. It recommends vaccination with PPSV23 for adults aged 65 and older, as well as younger adults with certain medical conditions that increase risk. PPSV23 protects against the 23 serotypes known to cause the majority of invasive pneumococcal disease. While it is effective at preventing severe disease, it may not prevent all cases of pneumococcal pneumonia.

1. Clinical Guidelines—
Pneumococcal
Vaccination in Older
Adults for the Prevention
of Pneumococcal
Disease

2. Background
Pneumococcal 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).
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3. Transmission
Pneumococcus is
•found in many people’s
noses and throats as a
type of bacteria, and
•spread by coughing,
sneezing or via contact
with respiratory
secretions.
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4. Everybody Is at Risk
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5. Those at Greatest Risk
Age Factors
The Very Young ≥65 Adults
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6. Those at Greatest Risk
Underlying Conditions
Long-Term Health Weakened Immune
Problems System
Heart or lung disease, sickle cell, Hodgkin’s lymphoma, leukemia, kidney
diabetes, alcoholism, cirrhosis, leaks failure, multiple myeloma, nephrotic
of cerebrospinal fluid, cochlear implant syndrome, HIV or AIDS, damaged or
no spleen, organ transplant
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7. Those at Greatest Risk
Weakened Respiratory Systems
Smokers Asthma Sufferers
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8. Clinical Syndromes
Pneumoccocus leads to serious infections of the
covering of the brain
(meningitis)
blood (bacteremia)
lungs (pneumonia)
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9. Clinical Syndromes
Mortality Rates
Pneumonia Bacteremia Meningitis
1 in 20 1 in 5 3 in 10
deaths deaths deaths
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10. Clinical Syndromes
Mortality Rates
The highest mortality for
bacteremia and
meningitis occurs among
the elderly and patients
with underlying
conditions.
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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
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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
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13. Pneumonia
Symptoms
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14. Bacteremia
More 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
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15. Bacteremia
Symptoms
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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
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17. Meningitis
Symptoms (Adults)
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18. Vaccination
Approximately half of deaths from pneumococcal
disease could be prevented by vaccinations.
50%
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19. PPSV23 Vaccine
Pneumococcal The 10 most PPSV23 protects
disease has common against 23
more than 90 serotypes serotypes, including
serotypes. cause 62% of those most likely to
invasive cause serious
disease disease.
worldwide.
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20. PPSV23 Vaccine
Efficacy
PPSV23 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 in
more than 80% of healthy adults.
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21. PPSV23 Vaccine
Efficacy
PPSV23 IS NOT
•a “pneumonia vaccine,”
•shown to provide protection against pneumococcal
pneumonia, and
•guaranteed to prevent infection and symptoms in all
people.
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22. PPSV23 Vaccine
Recommendations
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
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23. PPSV23 Vaccine
Recommendations
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
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24. PPSV23 Vaccine
Recommendations
Older adults and persons with chronic illnesses or
immunodeficiency may not respond well, if at all;
however,
it is still recommended because they are at high risk of
developing severe disease.
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25. PPSV23 Vaccine
Dosing
Only one dose is needed
with a few exceptions.
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26. PPSV23 Vaccine
Dosing Exceptions
Revaccination is recommended for
•People ≥65 years who got first dose younger than 65 and more than 5
years 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
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27. PPSV23 Vaccine
Exclusions
Anyone
•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.
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28. PPSV23 Vaccine
Risks
• 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
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29. PPSV23 Vaccine
Risks
PPSV23 cannot possibly cause pneumococcal
disease.
It is an inactivated vaccine that contains only a
portion of the microbe.
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30. PPSV23 Vaccine
Medicare Coverage
C
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31. PPSV23 Vaccine
Endorsements
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
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32. PPSV23 Vaccine
Pocket Guide
A laminated quick-reference tool from the CDC for
front-line healthcare personnel is available.
Order here: http://www.immunize.org/ppvguide/
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33. Contact
Sandy Pogones
spogones@primaris.org
314-374-6451
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34. Resources
From 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 Book
From the Immunization Action Coalition:
• Ask the Experts
• Vaccine Information
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