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VACCINATE ADULTS! March 17) from the Immunization Action Coalition — Volume 20 – Number 1 March 2016 (Content current as of VACCINATE ADULTS! March 17) from the Immunization Action Coalition — www.immunize.org Let’s Review! Healthy Patients Age 65 and Older Need Two Pneumococcal Vaccines Spaced One Year Apart Despite the fact that more than a year has elapsed times that of any other ATE section, with more years and older, as long as recommended spacing since the Centers for Disease Control and Preven- than 20,000 visits in January alone. intervals are honored between vaccine doses. tion (CDC) first published its recommendations Let’s review the details of these recommenda- Please make sure your patients are vaccinated for use of two different pneumococcal vaccines tions. In 2014, followed by an update in 2015, according to CDC recommendations with pneu- (Prevnar [pneumococcal conjugate vaccine, PCV13, CDC published the following recommendations mococcal vaccines. And patients 65 and older may Pfizer] and Pneumovax [pneumococcal polysac- for the use of two pneumococcal vaccines in be behind on other routinely recommended vac- charide vaccine, PPSV23, Merck]) in healthy adults healthy adults age 65 years and older:1 cines. Remember to check your patient’s immuni- age 65 years and older, confusion abounds about • Administer 1 dose of Prevnar (PCV13) to zation status for zoster and Tdap, as well as annual the details of these recommendations. people age 65 years and older if they have influenza vaccine. The Immunization Action Coalition (IAC) not received a dose in the past. FOOTNOTES receives frequent inquiries about the use of pneu- − One year later, administer 1 dose of 1 The 2014 recommendations titled “Use of 13-Valent mococcal vaccines in older adults, including “Can Pneumovax (PPSV23). Pneumococcal Conjugate Vaccine and 23-Valent Pneu- I give the two vaccines at the same visit?” or “How • If your patient already received a dose of mococcal Polysaccharide Vaccine Among Adults Aged many months should I wait between doses of the Pneumovax at age 65 or older: >65 Years: Recommendations of ACIP” are available at www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm. two vaccines?” IAC’s website for healthcare pro- − You don’t need to repeat Pneumovax. The 2015 recommendations titled “Intervals Between fessionals, www.immunize.org, continues to receive − However, make sure that all your patients PCV13 and PPSV23 Vaccines: Recommendations of ACIP” large numbers of visitors to its feature section age 65 and older who have not yet had are available at www.cdc.gov/mmwr/preview/mmwrhtml/ “Ask the Experts” (ATE) (www.immunize.org/ Prevnar receive one dose at least a year mm6434a4.htm. askexperts), where CDC experts answer ques- after the Pneumovax dose. 2 For patients vaccinated prior to age 65 due to high-risk conditions: tions about vaccines. The pneumococcal section (For patients who received any pneumococcal • If your patient received a dose of Prevnar at an age of ATE has been visited at a rate nearly three vaccine doses prior to age 65, see footnote 2.) younger than 65: In February, CDC published “Recommended − You do not need to repeat Prevnar. Adult Immunization Schedule, U.S., 2016 (see − Administer Pneumovax at age 65 years, allowing at least a 1-year interval between it and the earlier dose www.cdc.gov/vaccines/schedules/downloads/adult/ of Prevnar. What’s In This Issue adult-combined-schedule.pdf). The pneumococcal • If your patient received Pneumovax at an age younger vaccine recommendations are fully documented than 65: Healthy Patients >65 Need Two Pneumococcal in the schedule and its highly detailed footnotes. − You need to administer another dose of Pneumovax at age 65 or later (and at least 5 years after the last Vaccines Spaced One Year Apart ........................1 Medicare Part B fully covers pneumococcal dose), but first administer Prevnar if your patient vaccines. Both Prevnar and Pneumovax are cov- hasn’t had a dose, and then administer Pneumovax Ask the Experts: ered under Part B for Medicare recipients age 65 one year after the Prevnar dose. CDC Answers Your Questions ..............................1 Vaccine Highlights: Recommendations, Schedules and More .............................................5 to ensure they receive the PCV13 dose first? Screening Checklist for Vaccine Or should the provider not miss an oppor- Contraindications in Adults ...................................6 Ask the tunity to give the PPSV23 and refer patients elsewhere for PCV13 in a year? Standing Orders Templates Experts The Advisory Committee on Immunization Prac- Available for Adults ...............................................7 tices (ACIP) recommends that pneumococcal The Immunization Action Coalition extends thanks vaccine-naïve people age 65 years and older should Take a Stand! Register for IAC’s to our experts, medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, Standing Orders Workshops ................................8 Ask the Experts...continued on page 2 RN, MN, both with the National Center for Immu- • Vaccine Administration Guides: Copy nization and Respiratory Diseases at the Centers and Use Handy CDC-Reviewed Materials ...........9 for Disease Control and Prevention (CDC). MenB Vaccine Recommendations Immunization questions? and Standing Orders Template ..........................10 Pneumococcal vaccines • Email [email protected] Products You Can Purchase from IAC ............... 11 If a provider does not yet stock pneumo- • Call your state health coccal conjugate vaccine (PCV13, Prevnar 13, department (phone numbers IAC’s Immunization Resources Order Form .......12 Pfizer) for adults age 65 years and older but at www.immunize.org/ stocks pneumococcal polysaccharide vaccine coordinators) (PPSV23, Pneumovax 23, Merck), should that provider refer patients to another provider Vaccinate Adults! Ask the Experts...continued from page 1 IAC’s “Ask the Experts” team from the online at www.immunize.org/va Centers for Disease Control and Prevention Immunization Action Coalition receive PCV13 first, followed by PPSV23 one year 2550 University Ave. W., Suite 415 North later. If the provider is unwilling to stock PCV13, then Saint Paul, MN 55114 patients should be referred elsewhere to get PCV13 Phone: (651) 647-9009 Email: [email protected] first. The solution, of course, is to stock PCV13 and Websites: www.immunize.org PPSV23, both of which are covered by Medicare Part B. www.vaccineinformation.org www.immunizationcoalitions.org We have a healthy 66-year-old patient who received www.give2mcv4.org a dose of PPSV23 in January then received a dose Vaccinate Adults is a publication of the Immuni- of PCV13 five months later at a different facility. zation Action Coalition (IAC) for healthcare Should the PCV13 dose be repeated since it was professionals. Content is reviewed by the Centers for Disease Control and Prevention given earlier than the 1-year interval recommended (CDC) for technical accuracy. This publica- by ACIP? tion is supported in part by CDC Grant No. ACIP recommends that healthy people age 65 years Andrew T. Kroger, MD, MPH Donna L. Weaver, RN, MN U38IP000589. Content is solely the responsi- and older receive PCV13 first, then PPSV23 one year bility of IAC and does not necessarily represent the official views of CDC. ISSN 1526-1824. later. When PPSV23 has been given first, ACIP recom- mends an interval of one year before giving PCV13. Publication Staff assumed to be one calendar year. Receiving PPSV23 Editor: Deborah L. Wexler, MD What to do when doses of PPSV23 and PCV13 are Associate Editors: William L. Atkinson, given without the recommended minimum interval is a few days or weeks earlier than one calendar year after MD, MPH; Diane C. Peterson not addressed in the ACIP recommendations. The CDC PCV13 is not a medical problem. However, it could Consulting Editors: Teresa Anderson, DDS, subject matter experts have advised that in such a case, be a problem for reimbursement since Medicare will MPH; Marian Deegan, JD Editorial Assistant: Janelle T. Anderson, MA the dose given second does not need to be repeated. only pay for both vaccines if they are given at least 11 This is an exception to the usual procedure for a mini- months apart. Private insurance may have similar rules. IAC Staff Chief Strategy Officer: mum interval violation as described in ACIP’s General Here is the wording from the Centers for Medicare and L.J (Litjen) Tan, MS, PhD Recommendations on Immunization (see www.cdc.gov/ Medicaid (CMS): Associate Director for Research: mmwr/pdf/rr/rr6002.pdf, page 5). There is no evidence “ An initial pneumococcal vaccine may be admin- Sharon G. Humiston, MD, MPH to support that there are benefits to repeating the dose of Coordinator for Public Health: istered to all Medicare beneficiaries who have Laurel Wood, MPA PCV13. Information about the recommended intervals never received a pneumococcal vaccine under Nurse Consultant: Pat Vranesich, RN, BSN between pneumococcal vaccines can be found at www. Medicare Part B. A different, second pneumococ- Coordinator for Hepatitis B Projects: cdc.gov/mmwr/pdf/wk/mm6434.pdf, pages 944–7. Lynn Pollock, RN, MSN cal vaccine may be administered 1 year after the first vaccine was administered (i.e., 11 full months Perinatal Hepatitis B Consultant: Diabetes is an indication for giving PPSV23 to Beth Rowe-West, BSN have passed following the month in which the last patients younger than age 65 years. Does this Policy Consultant: Sarah R. Landry, MA pneumococcal vaccine was administered).” Sr. Admin. for Grants and Leadership:
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