“I know I need my annual flu shot, but is it time for another pneumonia shot?” This question is very common from patients this time of year and we all need to be aware that pneumococcal vaccine recommendations for patients 65 and older have recently changed.
In August, the Advisory Council on Immunization Practices recommended and last month the Centers for Disease Control and Prevention (CDC) published these new guidelines, thus making them official. The widely used Pneumovax 23 (PPSV23) vaccine is now being used in conjunction with a newer pneumococcal conjugate vaccine (PCV13). The new PCV13 covers 13 subtypes of Streptococcus pneumonia as compared to the PPSV23 which covers 23. However the PCV13 has been shown to have as good or better immune response (i.e. protection) than the PPSV23. Obviously using just the new PCV13 would leave one without protection to some strains of Streptococcus pneumonia (i.e. pneumococcus). Therefore, the recommendation is that patients 65 or older should receive both of these vaccines in series, separated by a period of 6-12 months. Studies have shown that the best response comes from giving the PCV13 first and then following with the PPSV23.
Confused yet? The ACIP offers the following scenarios as a guideline:
- If you are of age 65 or greater and have had no pneumococcal vaccinations in past
- It is recommended that you receive PCV13 then PPSV23 6-12 months later
- If you are of age 65 or greater and have received PPSV23 at age 65 or more
- It is recommended that PCV13 is given to you at least 1 year after the PPSV23
- If you are of age 65 or greater and received PPSV23 before age 65
- It is recommended that you receive PCV13 (at least 1 year after original PPSV23 given)
- And one further PPSV23 given 5 years after initial PPSV23 and 6-12 months after PCV13
If a patient has received a PCV13 prior to age 65 it should not be repeated, it is a once in a lifetime vaccine. The PCV13 and PPSV23 should not be given together and recommended minimal interval is 6 months. It is acceptable to give the PCV13 with the annual flu shot. Side effects from the PCV13 are similar to the PPSV23 and include pain, redness, and swelling at the injection site, temporary limitation of movement of the affected arm, headache, chills, and generalized muscle pain.
If you have questions please ask your provider at your next visit.
This article was written by Dr. Wesley Ratliff, MD, of Premier Healthcare, LLC on 10/28/2014
For details see MMWR September 19,2014/63(37); 822-825