24. Immunizations -- Pneumococcal Vaccines

Finish PCV13 series today -> 8 weeks -> PPSV23 -> 5 years -> PPSV23 -> Age 65 -> PPSV23 The PCV13 vaccination series is required for all patients < 5yo. This this patient would have received 4 doses starting as an infant. Since this child is immunocompromised, she will also need two doses of PPSV23 (required for immunocompromised patients age 2-64). You need to wait 8 weeks between the last dose of PCV13 and the first dose of PPSV23. After the first dose of PPSV23, you need to wait a minimum of five years before giving the second dose of PPSV23. After receiving the second dose, she will only need a dose of PPSV23 vaccine once she turns 65, since it is required for that age regardless of her having received the vaccine previously. She does not need an additional dose of PCV13 at 65yo, since you do not need to give a second dose of that vaccine at that age if you've already received it.

A 3 year old female with sickle cell disease who just finished the PCV13 series today should receive what pneumococcal vaccines in her lifetime? And why?

PCV13 x 1 today -> 8 weeks -> PPSV23 -> 5 years -> PPSV23 -> Age 65 -> PPSV23 An immunocompromised patient who has not previously received the PCV13 vaccine should be given that first. Since he is immunocompromised he should also receive two doses of the PPSV23 vaccine. Give the first dose of PPSV23 8 weeks after the PCV13, then wait 5 years before giving the second dose of PPSV23. After that, he only needs an additional dose of PPSV23 at age 65 since it is required at that age regardless of if you've received previous doses of PPSV23. He does not need an additional dose of PCV13 at that age since he received a dose previously.

A 43 year old patient newly diagnosed with HIV should receive what pneumococcal vaccines in his lifetime? Why?

PPSV23 x 1 today -> Age 65 -> PCV13 -> 1 year -> PPSV23 Immunocompetent patients 2-64 yo with certain conditions (i.e., diabetes), should receive 1 dose of PPSV23... he does not need PCV13 at his age since he is not immunocompromised. Once he turns 65 then he should receive the PCV13 vaccine since it is required for everyone at that age who have not previously received it. All patients older than age 65 also need a dose of PPSV23, regardless of if they've received a dose of the vaccine prior to age 65. In immunocompetent patients who have received the PCV13 vaccine, you need to wait a minimum 1 year before giving the PPSV23 (opposed to 8 weeks for immunocompromised patients)

A 50 yo male with newly diagnosed diabetes should receive what pneumococcal vaccines over his lifetime? And why?

PCV13 x 1 today -> 1 year -> PPSV23 Since the patient is 65 years old and has not received any pneumococcal vaccines prior, he will need one dose of PCV13 and one dose of PPSV23. The PCV13 takes higher priority and should be given first if both types of vaccines are indicated. In an immunocompetent patient, you need to wait a minimum of 1 year before giving the PPSV23 (opposed to 8 weeks for an immunocompromised patient).

A 65 yo male patient with no PMH should receive what pneumococcal vaccines? Why?

Must wait 1 year after Pneumovax 23 before giving Prevnar 13 (PPSV23 -> 1 year -> PCV13)

If Pneumovax 23 is given to a patient first, how long must you wait before giving Prevnar 13?

Give Prevnar 13 first

If Prevnar 13 and Pneumovax 23 are both indicated in a patient, which vaccine should you give first?

No -> Once the vaccine series has been given to a child, they are considered to be protected... No further doses are recommended, even if they develop conditions later in life.

If a child has been given the PCV13 series at birth, will they require additional PCV13 vaccine if they develop any conditions later in life where it could be indicated? (e.g., malignancy)

No -> If receiving the vaccine for the first time at ≥ 6yo, they will only need one dose of the vaccine.

If a child receives the Prevnar 13 (PCV13) vaccine for the first time at ≥ 6yo, will they require the multi-dose schedule that newborns receive?

Patients age 6-18 yo with certain conditions should receive one dose (e.g., diabetes, heart or lung disease, asthma if using high dose oral steroids)

If a patient older age 6-18yo has NEVER RECEIVED the Prevnar 13 (PCV13) vaccine, how should a catch-up regimen be implemented?

Doses of Pneumovax 23 should be separated by at least 5 years (PPSV23 -> 5 years -> PPSV23) Remember that immunocompromised patients age 2-64 will require 2 doses of PPSV23

If a patient requires two doses of Pneumovax 23, and has already received the first dose, how long must you wait before giving a second dose of PPSV23?

Give Pneumovax 23 1 year after Prevnar 13 (PCV13 -> 1 year -> PPSV23)

If both Prevnar 13 (PCV13) and Pneumovax 23 (PPSV23) are indicated in an immunocompetent patient, how should they be spaced?

Give Prevnar 13 before Pneumovax 23 (PCV13 -> PPSV23)

If both Prevnar 13 (PCV13) and Pneumovax 23 (PPSV23) are indicated in an immunocompetent patient, how should they be spaced?

Give Pneumovax 23 8 weeks after Prevnar 13 (PCV13 -> 8 weeks -> PPSV23)

If both Prevnar 13 (PCV13) and Pneumovax 23 (PPSV23) are indicated in an immunocompromised patient, how should they be spaced?

No further doses required

If you've received the childhood series of Prevnar 13, do you need further doses of PCV13 for any indication?

This allows the vaccines to be coordinated easily with annual checkups

In immunocompetent adults ≥ 65 years old with no previous history of having had pneumococcal vaccinations, why does Prevnar 13 need to be separated from Pneumovax 23 by at least one year?

Allows for protection more quickly

In immunocompromised patients who need both PPSV23 and PCV13, why are they spaced by only 8 weeks when they are spaced by a year in normal patients?

All adults > 64 years Some children and adults age 2-64 years

Pneumovax 23 (PPSV23) is given to populations of which ages?

Given IM

Prevnar 13 (PCV13) is given via what routes?

2 yo

What is the minimum age of immunization required for administration of Pneumovax 23 (PPSV23)?

6 weeks

What is the minimum age you need to be to receive the Prevnar 13 vaccine?

Approved in 2010... If a case does not state that the patient received the PCV13 vaccine previously (i.e., an elderly patient), it cannot be presumed that they received it...

When was Prevnar 13 (PCV13) vaccine approved by the FDA?

All children < 5 years Some age ≥ 6 yo if have risk factors All adults > 64 years (1 dose)

Which age groups should receive Prevnar 13 (PCV13) conjugate vaccine?

Immunocompetent patients age 2-64 with diabetes, heart, lung or liver dz, alcohol abuse, and those who smoke

Which patient populations should receive one dose of the Pneumovax 23 (PPSV23) vaccine before age 65? Opposed to two doses?

Immunocompromised patients age 2-64 (e.g., sickle cell disease, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drug use including steroids)

Which patient populations should receive two doses of the Pneumovax 23 (PPSV23) vaccine before age 65? Opposed to one dose?

Immunocompromised patients age 6-64 yo (e.g., sickle cell disease, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs, including steroids)

Which patients age 6-64 yo who have NEVER RECEIVED the Prevnar 13 (PCV13) vaccine should be given a dose?

All patients > 65 yo Note that some patients will receive up to 3 doses in their lifetime depending on if they're immunosuppressed

Which patients should receive one dose of the Pneumovax 23 (PPSV23) vaccine after age 65? Opposed to before?

Children < 2yo don't produce an adequate antibody response to polysaccharide vaccines (i.e., Pneumovax 23)

Why do children < 2 yo receive the Prevnar 13 vaccine opposed to the Pneumovax 23 vaccine?