D E I S L A O N H Pneumococcal Vaccination D

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D

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T Recommendations P

L A 1-4 COLLEGE OF R A Adults ≥19 Years PHARMACY T E M H DRUG INFORMATION F E N T O (Including updated recommendations for the use of PCV13 in Adults) SERVICES 401-874-9188 Healthy Adults ≥ 65

Pneumococcal Vaccination Previously vaccinated with Previously vaccinated with Naive or Unknown History PPSV23 at age ≥65 PPSV23 before age 65

≥ 1 year after PPSV23 GIVE: PCV13 ≥ 1 year after PPSV23 GIVE: PCV13 if not previously given

Wait ≥ 1 year* Wait ≥ 1 year* (and ≥ 5 years after PPSV23)

GIVE: PPSV23† GIVE: PCV13 if not previously given GIVE: PPSV23†

ADULTS ≥ 19 with UNDERLYING MEDICAL CONDITIONS (see chart on back) OR who SMOKE or live in a NURSING HOME Pneumococcal Vaccination Previously vaccinated with one Naive or Unknown History dose PPSV23 Vaccination is NOT indicated for healthy persons GIVE: PPSV23 19 - 64 years of age

While PCV13 is FDA-approved for persons > 50 years, the Advisory At Age ≥65 At Age ≥65 Committee on Immune Practices GIVE: PCV13 ≥ 1 year after PPSV23 GIVE: PCV13 ≥ 1year after PPSV23 does not provide guidance for use THEN: PPSV23† ≥ 1 year* after THEN: PPSV23† ≥ 1 year* after in this population. PCV13 and ≥ 5 years after PPSV23 PCV13 and ≥ 5 years after PPSV23

ADULTS ≥ 19 with IMMUNE COMPROMISING CONDITIONS (see chart on back), OR ASPLENIA (including sickle cell anemia), CEREBROSPINAL FLUID LEAK, or COCHLEAR IMPLANT

Pneumococcal Vaccination Previously vaccinated with one Previously vaccinated with Naive or Unknown History dose PPSV23 two doses of PPSV23

GIVE: PCV13 ≥ 1 year after PPSV23 ≥8 weeks* later GIVE: PCV13 if not previously given ≥ 1 year after PPSV23 If < 65 If ≥65 ≥8 weeks* later GIVE: PPSV23

If < 65 and If ≥65 GIVE: PCV13 if not previously given ≥ 5 years after If < 65 and PPSV23 ≥ 5 years after PPSV23 GIVE: second § GIVE: second PPSV23 PPSV23 §

At Age ≥65 At Age ≥65 At Age ≥ 65 GIVE: PPSV23† GIVE: PPSV23† GIVE: PPSV23† GIVE: PPSV23† ≥5 years after GIVE: PPSV23† ≥ 8 weeks* after ≥ 5 years after ≥ 5 years after PPSV23 PCV13 and ≥ 5 years after PPSV23 PPSV23 PPSV23

* Minimum intervalGIVE: between PPSV23 sequential administration of PCV13 and PPSV23 is 8 weeks in immunocompromised patients. For Medicare reimbursement interval must be 11 full months. Please refer to page 4. † The ACIP (Advisory Committee on Immunization Practices) recommends only 1 dose of PPSV23 at age ≥65. Revaccination is not necessary. § A second PPSV23 for patients with cerebrospinal fluid leak, or cochlear implant is not required. PPSV23=23-Valent Pneumococcal Polysaccharide Vaccine (Pneumovax®23) PCV13=13-Valent Pneumococcal Conjugate Vaccine (Prevnar 13®) © 2014 Rhode Island Board of Education D E I S L A O N Pneumococcal Vaccination Pneumococcal Vaccina>on H D Informa>on Sheet R

Pneumococcal Vaccina>on D Informa>on Sheet PCV13 (Prevnar 13®) and H PPSV23 (Pneumovax® 23) Pneumococcal Vaccina>on E Informa>on Sheet

T Recommendations PCV13 (Prevnar 13®) and P PPSV23 (Pneumovax® 23) L PCV13 (Prevnar 13®) and A PPSV23 1-5 (Pneumovax® COLLEGE 23) OF R A Adults ≥19 Years PHARMACY PCV13 (Prevnar13®) PPSV23 (Pneumovax®23) T E Pneumococcal Pneumococcal Vaccina>on Vaccina>on M H Informa>on Informa>on DRUG INFORMATION Sheet Sheet PCV13 (Prevnar13®) PPSV23 (Pneumovax®23) E F SERVICES PPSV23 (Pneumovax®23) N T O PCV13 (Prevnar13®) PCV13 PCV13 Manufacturer: Pneumococcal (Prevnar (Prevnar 13®) 13®) Vaccina>on and and PPSV23 (Including PPSV23 updated recommendations for the use of PCV13 Informa>on in (Pneumovax® Adults) 23) (Pneumovax® 23) 401-874-9188 Manufacturer: Sheet Merck Manufacturer: PCV13 (Prevnar 13®) and PPSV23 (Pneumovax® 23) Pfizer Manufacturer: Manufacturer: Manufacturer: www.merckvaccines.comMerck / PCV13 and PPSV23 Indications for Adults ≥ 19 Years* by Risk Group 2,3 www.pfizerpro.comPfizer PCV13 PCV13 / (Prevnar13®) (Prevnar13®) PPSV23 www.merckvaccines.comMerck PPSV23 (Pneumovax®23) (Pneumovax®23) / www.pfizerpro.comPfizer / How www.merckvaccines.com PPSV23 Supplied: (Pneumovax®23) / How www.pfizerpro.com Supplied: PCV13 / (Prevnar13®) Manufacturer: Manufacturer: How Pneumococcal Supplied: Vaccina>on PCV13 (Prevnar13 ®) Informa>on PPSV23 (Pneumovax®23) Manufacturer: Manufacturer: How Supplied: Sheet Manufacturer: 0.5ml Single Dose Vial Prefilled Manufacturer: Syringe Merck Merck 0.5ml How PCV13 Supplied: Single (Prevnar Dose Vial 13®) and Risk Group Underlying PPSV23 Medical Condition (Pneumovax® 23) Pfizer Pfizer Prefilled How Supplied: Syringe Merck Mul@-­‐Dose (5 dose Vial) Revaccinate 5 years (10 per Package) www.merckvaccines.comwww.merckvaccines.com0.5ml Single Dose / Vial / Recommended Recommended www.pfizerpro.comwww.pfizerpro.comPrefilled Pfizer Syringe / / Mul@-­‐Dose (5 dose Vial) after first dose (10 per Package) Storage Mul@-­‐Dose www.merckvaccines.com and (5 Handling dose : Vial) / Storage (10 www.pfizerpro.com per and Package) Handling/ : How How PPSV23 Supplied: Supplied: (Pneumovax®23) How How Supplied: Supplied: PCV13 (Prevnar13®) Refrigerate Storage and on Handling Arrival : Refrigerate Storage and on Handling Arrival : 0.5ml 0.5ml Storage How Single Supplied: Single and Dose Dose Handling Vial : Vial Persons with normal Cigarette smoker ✓ Prefilled Prefilled Storage How Supplied: Syringe Syringe and Handling: Store Refrigerate Manufacturer: at 2◦C on to 8◦C Arrival immune function Store Refrigerate Manufacturer: at 2◦C on to 8◦C Arrival Refrigerate 0.5ml Single on Dose Arrival Vial Refrigerate Prefilled Syringe on Arrival Mul@-­‐Dose Mul@-­‐Dose Store Merck at (5 2◦C (5 dose to 8◦C Vial) dose Vial) Chronic heart disease† ✓ (10 (10 Store Pfizer per per at Package) 2◦C Package) to 8◦C DO Mul@-­‐Dose NOT FREEZE (5 dose Vial) (10 DO per NOT Package) FREEZE DO Store www.merckvaccines.com NOT at 2◦C FREEZE to 8◦C / DO Store www.pfizerpro.com NOT at 2◦C FREEZE to 8◦C / Storage Storage Discard and aYer and Handling the Handling: : expira@on date § Storage Storage Discard and aYer and Handling the Handling: : expira@on date DO NOT FREEZE Chronic lung disease ✓ DO NOT FREEZE Refrigerate Refrigerate Storage Discard aYer on and on Arrival the Handling Arrival : expira@on date Refrigerate Refrigerate Storage Discard aYer on and on Arrival the Handling Arrival : expira@on date Special Discard How Pneumococcal Supplied: instruc7ons: aYer the expira@on Vaccina>on date Informa>on Special Discard How Supplied: Sheet instruc7ons: aYer the expira@on date Store Store Refrigerate Pneumococcal at at 2◦C 2◦C on to 8◦C to 8◦C Arrival Vaccina>on Diabetes mellitus Informa>on ✓ Store Store Refrigerate at at Sheet 2◦C 2◦C on to 8◦C to 8◦C Arrival None Special 0.5ml PCV13 Pneumococcal Single instruc7ons: (Prevnar Dose Vial 13®) Vaccina>on and PPSV23 Informa>on (Pneumovax® 23) Shake Prefilled Special Sheet well instruc7ons: Syringe to obtain a homogeneous white suspension Special Store PCV13 at instruc7ons: (Prevnar 2◦C to 8◦C 13®) and PPSV23 (Pneumovax® 23) Special Store at instruc7ons: 2◦C to 8◦C DO DO None Mul@-­‐Dose PCV13 NOT NOT (Prevnar FREEZE FREEZE (5 dose 13®) Vial) and PPSV23 (Pneumovax® 23) DO DO (10 Shake NOT per NOT well FREEZE Package) FREEZE to obtain a homogeneous white suspension None DO NOT FREEZE Cerebrospinal fluid leak ✓ ✓ Shake DO NOT well FREEZE to obtain a homogeneous white suspension Discard Discard Route PPSV23 aYer of aYer the (Pneumovax®23) Administra7on: the expira@on expira@on date date Discard Discard Route aYer of aYer the Administra7on: PCV13 the expira@on expira@on date (Prevnar13®) date 0.5mL Storage Route Discard of IM aYer and or Administra7on: SQ the Handling: expira@on date £ 0.5mL Storage Route Discard of IM aYer and Administra7on: ONLY PCV13 the Handling: expira@on (Prevnar13®) date Route PPSV23 of (Pneumovax®23) Administra7on: Cochlear implant ✓ ✓ Route of Administra7on: PCV13 (Prevnar13®) Special Special Refrigerate 0.5mL Pneumococcal PPSV23 instruc7ons: IM instruc7ons: on (Pneumovax®23) or SQ Arrival Vaccina>on Informa>on Special Special Refrigerate 0.5mL instruc7ons: Sheet IM instruc7ons: on ONLY Arrival Manufacturer: Special instruc7ons: Manufacturer: Special instruc7ons: None None 0.5mL Manufacturer: IM or SQ Alcoholism Shake Shake 0.5mL Manufacturer: well well IM to ONLY to obtain obtain a a homogeneous homogeneous white suspension white suspension Merck Manufacturer: Store PCV13 at (Prevnar 2◦C to 8◦C 13®) and PPSV23 Insurance ✓ (Pneumovax® 23) Carrier Pfizer Manufacturer: Store at Informa>on: 2◦C to 8◦C None Merck Shake Pfizer well to obtain a homogeneous white suspension Route Route www.merckvaccines.comMerck DO of NOT of Administra7on: FREEZE Administra7on: / Insurance Carrier Route Route www.pfizerpro.comPfizer DO of NOT of Informa>on: Administra7on: FREEZE Administra7on: / www.merckvaccines.com/ Chronic liver disease,Insurance cirrhosis ✓ Carrier www.pfizerpro.com Informa>on:/ 0.5mL 0.5mL www.merckvaccines.comRoute Discard PPSV23 IM of IM 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Carrier for Prefilled both Informa>on: Informa>on: the Syringe cost of the vaccine and its administraDon Mul@-­‐Dose 0.5ml None Merck Single (5 Dose dose Vial Vial) (Please refer to reference 3 for (10 Prefilled Shake Pfizer per well Syringe Package) to obtain a homogeneous white suspension Mul@-­‐Dose (5 dose BCBS Vial) of specific RI www.bcbsri.com/providers guidance.) 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PPSV23 ¶ Includes B- are (humoral) or T-lymphocyteContraindica>ons deficiency, complement deficiencies both (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding inac@vated chronic granulomatous disease). and vaccines. Precau>ons: You can give all other recommended vaccina@ons at Route las@ng of 1-­‐2 Administra7on: BCBS days. RI of Department ** Those RI www.bcbsri.com/providers requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation. of Side Side Health Effects: Route Effects: State of 401-­‐274-­‐4848 Administra7on: Supplied Vaccina7on Program 1-­‐800-­‐230-­‐9050 • the Do same not give visit Drug PPSV23 Informa>on EXCEPT Medicare or if www.medicarenhic.com the PCV13 Services Side person to 401-­‐874-­‐9188 Effects: pa@ents is a who have a history of serious 1-­‐866-­‐801-­‐5304 candidate reac@on Monday-­‐Friday for :00 8:30 am-­‐4 (e.g., pm MCV4 EST anaphylaxis) and PCV13. 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Use ofwww.health.ri.gov/resources/immuniza>on/ 13-valent pneumococcal by conjugate or vaccine and 23-valent pneumococcal a polysaccharide vaccine PCV13 among adults aged dose ≥ 19 years: Recommendations of the Advisory to of pa@ents PPSV23 at who have a history of serious least reac@on 8 weeks (e.g., later. anaphylaxis) Give adults PCV13 12 months aYer the aYer most PCV13 recent first, Drug followed Medicare dose Informa>on Committee of Part on Immunization PPSV23. by Practices (ACIP). MMWR Morb B Mortal Wkly Rep. a 2014;63(37):822-825. reimburses Services dose of for 401-­‐874-­‐9188 PPSV23 both the at cost least of the 8 Monday-­‐Friday :00 8:30 am-­‐4 weeks vaccine and its administraDon pm EST later. Give adults PCV13 12 months aYer the Source Source a of of previous informa@on; informa@on; UnitedHealthCare dose Immuniza@on Immuniza@on of Ac@on Ac@on Coali@on (www.immunize.org PCV13, Coali@on (www.immunize.org www.unitedhealthcareonline.com PPSV, ) in ) or in collabora@on collabora@on one with of their components. with the the Na@onal 1-­‐877-­‐842-­‐3210 Na@onal Adult Adult and and Influenza Influenza Immuniza@on Summit Immuniza@on Summit most recent dose 4. Kobayashi of M, Bennett PPSV23. NM, Gierke R, et al. Intervals between PCV13 and PPSV23 vaccines: Recommendations of the Advisory Committee in Immunization Practice (ACIP) (www.preven@nfluenza.org(•www.preven@nfluenza.org most Most recent common ); ); accessed dose accessed side September of September effects PPSV23. 4, 4, from 2013. 2013. MMWR either MMWR 2012; 2012; 61(40):816-­‐819. 61(40):816-­‐819. PPSV23 or PCV13 are soreness and redness at the injec@on site, Source of informa@on; Immuniza@on MMWR Morb Mortal Wkly Rep. Ac@on Contraindica>ons 2015; 64(34): 944-947. Coali@on (www.immunize.org) in collabora@on and Precau>ons: with the Na@onal Adult and Influenza Immuniza@on Summit •(www.preven@nfluenza.orglas@ng PCV13 1-­‐2 and ); days. PPSV23 accessed September are both 4, 2013. inac@vated MMWR 2012; 61(40):816-­‐819. vaccines. You can give all other recommended vaccina@ons at • PCV13 Do not and give BCBS PPSV23 RI PPSV23 of Department 5. Rubin RI www.bcbsri.com/providers LG, Levin are MJ, Davies EG, et al. 2013 IDSA and clinical practice guideline both for vaccination of the immunocompromised PCV13 host. Clin of Infect Dis. 2014;58:e44-e100. inac@vated doi: 10.1093/cid/cit684. Health simultaneously. State vaccines. 401-­‐274-­‐4848 You can give all Supplied For pa@ents who need other both recommended Vaccina7on PCV13 Program 1-­‐800-­‐230-­‐9050 and vaccina@ons PPSV23, give at • the PCV13 Do same not and give visit PPSV23 PPSV23 EXCEPT are or if both the PCV13 inac@vated person to pa@ents is vaccines. a who have a history of serious You can give all other candidate reac@on recommended for (e.g., MCV4 vaccina@ons anaphylaxis) and PCV13. If using MCV4-­‐D (Menactra®) at aYer • the PCV13 same first, visit followed EXCEPT www.health.ri.gov/resources/immuniza>on/ by if a the dose person of PPSV23 is a at candidate least 8 for weeks MCV4 later. and PCV13. If using MCV4-­‐D (Menactra®) Give adults PCV13 12 months aYer the give the a previous same PCV13 visit Drug UnitedHealthCare first, dose Informa>on EXCEPT wait of PCV13, if 4 www.unitedhealthcareonline.com the Services weeks PPSV, person or and 401-­‐874-­‐9188 then is one of their components. a give candidate 1-­‐877-­‐842-­‐3210 MCV4-­‐D. Monday-­‐Friday for :00 8:30 am-­‐4 pm MCV4 If EST using and PCV13. If using MCV4-­‐D (Menactra®) MCV4-­‐CRM (Menveo®) both can be given give most PCV13 recent first, dose wait of PPSV23. 4 weeks and then give MCV4-­‐D. If using MCV4-­‐CRM (Menveo®) both can be given Source at give of the informa@on; PCV13 same first, visit. Immuniza@on wait You Ac@on Contraindica>ons Coali@on (www.immunize.org 4 cannot weeks ) give in and collabora@on and then PCV13 give Precau>ons: with and PPSV23 simultaneously. the MCV4-­‐D. Na@onal Adult If and using Influenza Immuniza@on Summit MCV4-­‐CRM (Menveo®) both can be given •(www.preven@nfluenza.org at PCV13 Do the not and give same ); PPSV23 accessed visit. RI PPSV23 Department September are You and both 4, cannot PCV13 of 2013. inac@vated Health give MMWR simultaneously. 2012; PCV13 State 61(40):816-­‐819. vaccines. You can give all and PPSV23 simultaneously. Supplied For pa@ents who need other both recommended Vaccina7on PCV13 Program and vaccina@ons PPSV23, give at Do not give PPSV23 or PCV13 to pa@ents who have a history of serious reac@on (e.g., anaphylaxis) aYer • the PCV13 same first, visit followed EXCEPT www.health.ri.gov/resources/immuniza>on/ by if a the dose Side person of Effects: PPSV23 is a at candidate least 8 for weeks MCV4 later. and PCV13. If using MCV4-­‐D (Menactra®) Give adults PCV13 12 months aYer the a previous dose of PCV13, PPSV, Side or Effects: one of their components. give most PCV13 recent first, dose wait of PPSV23. 4 weeks Side and Effects: then give MCV4-­‐D. If using MCV4-­‐CRM (Menveo®) both can be given • Most common side effects from either PPSV23 or PCV13 are soreness and redness at the injec@on site, • Most common side effects Contraindica>ons from either and PPSV23 Precau>ons: or PCV13 are soreness and redness at the injec@on site, • las@ng at Most PCV13 Do the not common 1-­‐2 and give same days. PPSV23 visit. side PPSV23 effects are You and both cannot from PCV13 inac@vated either give simultaneously. PCV13 vaccines. PPSV23 You can give all and PPSV23 simultaneously. For pa@ents who need other or PCV13 are soreness and both recommended redness PCV13 at and vaccina@ons the PPSV23, give at injec@on site, las@ng Do not 1-­‐2 give days. PPSV23 or PCV13 to pa@ents who have a history of serious reac@on (e.g., anaphylaxis) aYer • las@ng the PCV13 same 1-­‐2 first, visit days. followed EXCEPT by if a the dose person of PPSV23 is a at candidate least 8 for weeks MCV4 later. and PCV13. If using MCV4-­‐D (Menactra®) Give adults PCV13 12 months aYer the a previous dose of PCV13, PPSV, Side or Effects: one of their components. give most PCV13 recent Drug first, dose Informa>on wait of PPSV23. 4 Services weeks and 401-­‐874-­‐9188 then give MCV4-­‐D. Monday-­‐Friday 8:30 am-­‐4:00 pm If EST using MCV4-­‐CRM (Menveo®) both can be given Drug Informa>on Services 401-­‐874-­‐9188 Monday-­‐Friday 8:30 am-­‐4:00 pm EST Source • at Do Most of the not informa@on; common give same visit. Immuniza@on side PPSV23 effects You Ac@on and Coali@on (www.immunize.org cannot from PCV13 ) either give simultaneously. in collabora@on PCV13 PPSV23 with and PPSV23 simultaneously. For pa@ents who need or PCV13 are soreness the and both Na@onal redness PCV13 Adult and at and Influenza the Immuniza@on Summit PPSV23, give injec@on site, •Source (www.preven@nfluenza.org PCV13 of informa@on; and ); PPSV23 accessed Immuniza@on September are Ac@on Coali@on (www.immunize.org both 4, 2013. inac@vated ) MMWR in collabora@on 2012; 61(40):816-­‐819. vaccines. with You can give all other the Na@onal recommended Adult and Influenza vaccina@ons Immuniza@on Summit at Source (www.preven@nfluenza.orglas@ng of informa@on; 1-­‐2 ); days. accessed Immuniza@on September Ac@on Coali@on (www.immunize.org 4, 2013. ) MMWR in collabora@on 2012; 61(40):816-­‐819. with the Na@onal Adult and Influenza Immuniza@on Summit (www.preven@nfluenza.orgthe PCV13 same first, visit ); followed accessed EXCEPT September by if a 4, the dose 2013. Side person MMWR of Effects: 2012; PPSV23 is 61(40):816-­‐819. a at candidate least 8 for weeks MCV4 later. and PCV13. If using MCV4-­‐D (Menactra®) Give adults PCV13 12 months aYer the most recent dose of PPSV23. give PCV13 Drug first, Informa>on wait 4 Services weeks and 401-­‐874-­‐9188 then give MCV4-­‐D. Monday-­‐Friday :00 8:30 am-­‐4 pm If EST using MCV4-­‐CRM (Menveo®) both can be given • at Most the common same visit. side effects You cannot from either give PCV13 PPSV23 and PPSV23 simultaneously. or PCV13 are soreness and redness at the injec@on site, •Source PCV13 of informa@on; and PPSV23 Immuniza@on are Ac@on Coali@on (www.immunize.org both inac@vated ) in collabora@on vaccines. with You can give all other the Na@onal recommended Adult and Influenza vaccina@ons Immuniza@on Summit at (www.preven@nfluenza.orglas@ng 1-­‐2 ); days. accessed September 4, 2013. MMWR 2012; 61(40):816-­‐819. the same visit EXCEPT if the Side person Effects: is a candidate for MCV4 and PCV13. If using MCV4-­‐D (Menactra®) give PCV13 Drug first, Informa>on wait 4 Services weeks and 401-­‐874-­‐9188 then give MCV4-­‐D. Monday-­‐Friday :00 8:30 am-­‐4 pm If EST using MCV4-­‐CRM (Menveo®) both can be given • at Most the common same visit. side effects You cannot from either give PCV13 PPSV23 and PPSV23 simultaneously. or PCV13 are soreness and redness at the injec@on site, Source of informa@on; Immuniza@on Ac@on Coali@on (www.immunize.org) in collabora@on with the Na@onal Adult and Influenza Immuniza@on Summit (www.preven@nfluenza.orglas@ng 1-­‐2 ); days. accessed September 4, 2013. MMWR 2012; 61(40):816-­‐819. Side Effects: Drug Informa>on Services 401-­‐874-­‐9188 Monday-­‐Friday :00 8:30 am-­‐4 pm EST • Most common side effects from either PPSV23 or PCV13 are soreness and redness at the injec@on site, Source of informa@on; Immuniza@on Ac@on Coali@on (www.immunize.org) in collabora@on with the Na@onal Adult and Influenza Immuniza@on Summit (www.preven@nfluenza.orglas@ng 1-­‐2 ); days. accessed September 4, 2013. MMWR 2012; 61(40):816-­‐819. Drug Informa>on Services 401-­‐874-­‐9188 Monday-­‐Friday :00 8:30 am-­‐4 pm EST

Source of informa@on; Immuniza@on Ac@on Coali@on (www.immunize.org) in collabora@on with the Na@onal Adult and Influenza Immuniza@on Summit (www.preven@nfluenza.org); accessed September 4, 2013. MMWR 2012; 61(40):816-­‐819. Pneumococcal Vaccination Information Sheet ®) and PPSV23 (Pneumovax® 23) PCV13 (Prevnar 13 COLLEGE OF PHARMACY

Facts About Pneumococcal Disease: • Streptococcus pneumoniae bacteria (i.e., pneumococci) are usually found in the upper respiratory tract of most people.

• Pneumococcal disease most commonly presents as a serious infection in the lungs (pneumonia), blood (bacteremia), or brain (meningitis). The annual U.S. case estimate for invasive pneumococcal disease (bacteremia and/or meningitis) is 40,000 and 4,250 deaths.

• Pneumococcal disease most often occurs in older people as well as in people with a predisposing condition (e.g., immunosuppression, pulmonary disease, heart disease, diabetes). The disease rates for adults in these groups can be more than 20 times those for adults without high-risk medical conditions.

• PPSV23 is 60–70% effective in preventing serious pneumococcal disease; it does not provide substantial protection against all types of pneumonia (viral and bacterial). It is not a “pneumonia” vaccine.

Frequently Asked Questions: Question: Can I get the influenza and pneumococcal vaccines at the same time? Yes. These vaccines can be given at the same time. If giving two IM vaccinations, separate by one inch in the body muscle to reduce likelihood of local reactions overlapping.

Question: If patients who are in a recommended risk group for PPSV23 or PCV13 aren’t sure if they have previously received these vaccines, should healthcare providers vaccinate them? Yes. If patients do not have a documented vaccination history for these two vaccines and their records are not readily obtainable, you should administer the recommended doses. Extra doses will not cause harm to the patient.

Question: Is an egg allergy a contraindication for PCV13 or PPSV23? No. Both vaccinations are safe for persons with egg allergies.

Question: If my state has a registry, do I still need to give patients vaccine record cards? Yes. Patient-held cards are an extremely important part of a person’s medical history. The person may move to an area without a registry, and a personal record may be the only vaccination record available. In addition, even within a state, all healthcare providers may not participate in the registry, and the personal record card would be needed.

Question: My patient has had laboratory-confirmed pneumococcal pneumonia. Does he/she still need to be vaccinated with PPSV23? Yes. There are more than 90 known serotypes of pneumococcus (23 serotypes are in the current vaccine). Infection with one serotype does not necessarily produce immunity to other serotypes. As a result, if the person is a candidate for vaccination, he/she should receive it even after one or more episodes of invasive pneumococcal disease.

Question: Why is pneumococcal vaccination recommended for smokers and asthmatics? In 2008, the Advisory Committee on Immunization Practices (ACIP) reviewed new information that suggests that asthma is an independent risk factor for pneumococcal disease among adults. ACIP also reviewed new information that demonstrates an increased risk of pneumococcal disease among smokers. Consequently, ACIP recommends to include both asthma and cigarette smoking as risk factors for pneumococcal disease among adults age 19 through 64 years and as indications for PPSV23.

Acquired from www.immunize.org on September 4, 2013. We thank the Immunization Action Coalition. MMWR Morb Mortal Wkly Rep 2012; 61(40):816-819. Pneumococcal Vaccination Information Sheet PCV13 (Prevnar 13®) and PPSV23 (Pneumovax® 23) COLLEGE OF PHARMACY

PPSV23 (Pneumovax®23) PCV13 (Prevnar13®) Manufacturer: Manufacturer: Merck Pfizer www.merckvaccines.com/Products/Pneumovax/Pages/home http://www.pfizerpro.com/hcp/prevnar13

How Supplied: How Supplied: 0.5mL Single Dose Vial Prefilled Syringe Multi-Dose (5 dose Vial) (10 per Package)

Storage and Handling: Storage and Handling: Refrigerate on Arrival Refrigerate on Arrival Store at 2◦C to 8◦C Store at 2◦C to 8◦C DO NOT FREEZE DO NOT FREEZE Discard after the expiration date Discard after the expiration date

Special instructions: Special instructions: None Shake well to obtain a homogeneous white suspension

Route of Administration: Route of Administration: 0.5mL IM or SQ 0.5mL IM ONLY Insurance Carrier Information: Medicare www.medicarenhic.com 1-866-801-5304* BCBS of RI www.bcbsri.com/providers 401-274-4848 1-800-230-9050 UnitedHealthCare www.unitedhealthcareonline.com 1-877-842-3210 RI Department of Health State Supplied Vaccination Program www.health.ri.gov/resources/immunization/ Contraindications and Precautions: • Do not give PPSV23 or PCV13 to patients who have a history of a serious reaction (e.g., anaphylaxis) after a previous dose of PCV13, PPSV23, or one of their components.

• Do not give PPSV23 and PCV13 simultaneously. For vaccine naive patients, give PCV13 first, followed by a dose of PPSV23 ≥ 1 year† (unless patient in a population specified by ACIP to require shorter interval, see page 1). For patients who have already received PPSV23, give PCV13 12 months after the most recent dose of PPSV23.

• Vaccine Co-administration: (1) all vaccines used for routine vaccination in the United States can be given on the same day; (2) an inactivated vaccine can be administered either on the same day as or at any time before or after another inactivated or a live vaccine; and (3) any 2 LIVE vaccines that are not given on the same day must be spaced at least 4 weeks apart. Zoster vaccine is a live, attenuated vaccine; injectable influenza vaccine and pneumococcal polysaccharide vaccine are inactivated vaccines. So these 3 vaccines can be given on the same day or at any time before or after each other. They should be given as separate injections, not combined in the same syringe.

Side Effects: • Most common side effects from either PPSV23 or PCV13 are soreness and redness at the injection site, lasting 1-2 days. Drug Information Services 401-874-9188 Monday-Friday 8:30 am - 4:00 pm EST * An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B.A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered (i.e., 1 full months have passed following the month in which the last pneumococcal vaccine was administered). Please note that the “interval” between the two different pneumococcal vaccines must be at least 11 full months or greater for Medicare reimbursement, not the shorter “interval” recommended for specific populations identified by ACIP. Acquired from www.immunize.org on September 4, 2013. We thank the Immunization Action Coalition. † Kobayashi M, Bennett NM, Gierke R, et al. Intervals between PCV13 and PPSV23 vaccines: Recommendations of the Advisory Committee in Immunization Practice (ACIP) MMWR Morb Mortal Wkly Rep. 2015; 64(34): 944-947.