Thursday, September 29, 2022

Indications For Pneumonia Vaccine Before 65

Heptavalent Pneumococcal Conjugate Vaccine

ACIP Pneumococcal Vaccination Recommendations for 2022: Whats New? | ACP

A 7-valent pneumococcal conjugate vaccine has been introduced by Wyeth Lederle for use in children. The FDA has approved of this protein-polysaccharide conjugate vaccine for prevention of invasive pneumococcal disease in infants and toddlers.

The American Academy of Pediatrics and the CDC’s ACIP recommended pneumococcal polyvalent vaccine for routine use in all children 2 and under, and for black, Alaskan Native, and Native American toddlers up to age 5, as well as for those with sickle-cell anemia, HIV infection, or other immunodeficiency diseases. For infants, the AAP and ACIP recommends that the vaccine be given in 4 doses at 2, 4, 6, and 12 to 15 months for children who are 7 to 11 months, 3 doses for children who are 12 to 23 months, 2 doses and for children 2 years or older, only 1 dose is needed. See table below.

Table: Numbers of doses of Prevnar recommended by the ACIP for average risk children in each age range

Age range
24 to 591

Pneumococcus is the most frequent cause of otitis media, pneumonia, and bacteremia in children, as well as the principle cause of childhood bacterial meningitis. The most susceptible to pneumococcal diseases are children less than 2 years old. Standard pneumococcal polysaccharide vaccines are poorly immunogenic in this age group. The new protein-polysaccharide conjugate vaccine is immunogenic during infancy and is capable of providing long-term immunity.

Persons With Inadequate Immunization Records

Children and adults lacking adequate documentation of immunization should be considered unimmunized and should be started on an immunization schedule appropriate for their age and risk factors. Pneumococcal vaccines may be given, regardless of possible previous receipt of the vaccines, as adverse events associated with repeated immunization have not been demonstrated. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information about vaccination of people with inadequate immunization records.

Persons With Chronic Diseases

Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional information about vaccination of people with chronic diseases.

Asplenia or hyposplenia

Hyposplenic or asplenic individuals should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine, followed by a booster dose of Pneu-P-23 vaccine. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.

Chronic kidney disease and patients on dialysis

Individuals with chronic kidney disease should receive age appropriate pneumococcal vaccines. Children less than 18 years of age with chronic kidney failure or nephrotic syndrome, should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine. Adults with chronic kidney failure should receive Pneu-P-23 vaccine. Adults with nephrotic syndrome should receive Pneu-C-13 and Pneu-P-23 vaccine. Due to the decreased immunogenicity and efficacy of Pneu-P-23 vaccine in children and adults with chronic kidney failure, 1 booster dose of Pneu-P-23 vaccine is recommended. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.

Neurologic disorders

Chronic lung disease, including asthma

Chronic heart disease

Chronic liver disease

Endocrine and metabolic diseases

Non-malignant hematologic disorders

Cochlear implants

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Children At High Risk Of Ipd

Infants at high risk of IPD due to an underlying medical condition should receive Pneu-C-13 vaccine in a 4 dose schedule at 2 months, 4 months and 6 months followed by a dose at 12 to 15 months of age. Table 3 summarizes the recommended schedules for Pneu-C-13 vaccine for infants and children at high risk of IPD due to an underlying medical condition by pneumococcal conjugate vaccination history.

In addition to Pneu-C-13 vaccine, children at high risk of IPD due to an underlying medical condition should receive 1 dose of Pneu-P-23 vaccine at 24 months of age, at least 8 weeks after Pneu-C-13 vaccine. If an older child or adolescent at high risk of IPD due to an underlying medical condition has not previously received Pneu-P-23 vaccine, 1 dose of Pneu-P-23 vaccine should be administered, at least 8 weeks after Pneu-C-13 vaccine. Children and adolescents at highest risk of IPD should receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization. Refer to Immunocompromised persons for information about immunization of HSCT recipients.

Table 3: Recommended Schedules for Pneu-C-13 Vaccine for Children 2 months to less than 18 years of age, by Pneumococcal Conjugate Vaccination History

Age at presentation for immunizationNumber of doses of Pneu-C-7, Pneu-C-10 or Pneu-C-13 previously received

This Infectious Disease Can Pose A Serious Health Risk For Those Age 65 And Older But Two Vaccines Can Offer Sound Protection

Navigating Pneumococcal Vaccination in Adults  Consult QD

One of the leading health dangers for older adults is pneumonia. It is the most common cause of hospital admissions after childbirth. In fact, adults age 65 and older have a higher risk of death from pneumonia hospitalization than any other reason.

Pneumonia is an infection of the lungs by bacteria, viruses, or other microbes. Most cases are caused by the bacteria Streptococcus pneumoniae, Mycoplasma pneumonia, Chlamydia pneumoniae, Chlamydia psittaci, and Legionella pneumophila. A similar inflammation of the lung, called pneumonitis, can be caused by an inhaled chemical and is more common in people who have had strokes and have difficulty swallowing. A physical exam, chest x-ray, and blood test can confirm a diagnosis.

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Even Healthy People Need Vaccines

Many people still think of immunizations are for children they just don’t think of getting these, or they think, “Why should I do that if I’m healthy?”

There are other barriers to getting vaccines among adults, which were outlined in an article published by The American Journal of Medicine.

This article reported that self-reported immunization rates for tetanus, influenza and pneumococcal vaccines were lower than the national guideline goal rates. Common consumer-reported barriers included:

  • Lack of physician recommendations
  • Incorrect assumptions

Surveyed health care providers suggested additional barriers facing patients include:

  • Fear of needles
  • Perceived side effects
  • Lack of insurance coverage

To increase immunization rates, it’s important to overcome these barriers, such as the widespread myth that vaccines are unsafe and commonly cause serious side effects.

Vaccines have minimal risks and are generally very safe

The risks for vaccines among people age 65 and older are the same as any population, aside from the possibility of less effectiveness with age.

Serious complications are very rare for most patients, the benefits significantly outweigh the risks involved.

The influenza vaccine is made with completely dead forms of the influenza virus, and there is no scientific way you can get the flu from the vaccine. This vaccine is generally safe for all patients over six months of age.

Vaccines Help Maintain Your Health

Vaccines have minimal risks and are generally very safe. Even healthy people need vaccines. Ask your health care provider about these vaccines at your next appointment to determine what is best for your preventative health.

Michelle Twombly, CNP, is a certified nurse practitioner at UH Family Medicine Center in Strongsville.

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What Is A Pneumococcal Vaccine

A pneumococcal vaccine is an injection that can prevent pneumococcal disease. A pneumococcal disease is any illness that is caused by pneumococcal bacteria, including pneumonia. In fact, the most common cause of pneumonia is pneumococcal bacteria. This type of bacteria can also cause ear infections, sinus infections, and meningitis.

Adults age 65 or older are amongst the highest risk groups for getting pneumococcal disease.

To prevent pneumococcal disease, there are two types of pneumococcal vaccines: the pneumococcal polysaccharide vaccine and the pneumococcal conjugate vaccine .

Who Should Have The Pneumococcal Vaccine

New CDC guidelines for shingles and pneumonia vaccines

Anyone can get a pneumococcal infection. But some people are at higher risk of serious illness, so it’s recommended they’re given the pneumococcal vaccination on the NHS.

These include:

  • babies
  • adults aged 65 or over
  • children and adults with certain long-term health conditions, such as a serious heart or kidney condition

Babies are offered 2 doses of pneumococcal vaccine, at 12 weeks and at 1 year of age.

People aged 65 and over only need a single pneumococcal vaccination. This vaccine is not given annually like the flu jab.

If you have a long-term health condition you may only need a single, one-off pneumococcal vaccination, or a vaccination every 5 years, depending on your underlying health problem.

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Are Both Pneumococcal Vaccines Safe

Both vaccines are safe. As with any medicine there is always the possibility of a serious problem, such as an allergic reaction. But with PCV and PPSV , the risk of serious harm or death is extremely small.

In studies involving nearly 60,000 doses of the PCV vaccine, there have been no moderate or severe reactions. The mild side effects included:

  • Redness, tenderness, or swelling where the shot is given in about one out of every four infants
  • Fever higher than 100.4 F in about one out of every three infants
  • Fever higher than 102.2 F in about one out of every 50 children
  • Occasional incidence of fussiness, drowsiness, or loss of appetite

About one out of every two adults who receive the PPSV vaccine experiences redness or pain where the shot is given. Less than 1% have a more severe reaction, such as a fever or muscle aches.

What Are The Possible Side Effects Of Pcv And Ppsv Vaccines

Kids may have redness, tenderness, or swelling where the shot was given. A child also might have a fever after getting the shot. There is a very small chance of an allergic reaction with any vaccine.

The pneumococcal vaccines contain only a small piece of the germ and so cannot cause pneumococcal disease.

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Vaccination Of Infants Children And Adults 65 Years Or Older

CDC recommends routine administration of pneumococcal conjugate vaccine for all children younger than 2 years of age:

  • Give PCV13 to infants as a series of 4 doses, one dose at each of these ages: 2 months, 4 months, 6 months, and 12 through 15 months.
  • Children who miss their shots or start the series later should still get the vaccine. The number of doses recommended and the intervals between doses will depend on the childs age when vaccination begins.

View current schedules for children, teens, and adults.

CDC recommends routine administration of pneumococcal polysaccharide vaccine for all adults 65 years or older. In addition, CDC recommends PCV13 based on shared clinical decision-making for adults 65 years or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and have never received a dose of PCV13. Clinicians should consider discussing PCV13 vaccination with these patients to decide if vaccination might be appropriate. See Pneumococcal Vaccination: Summary of Who and When to Vaccinate for CDC guidance for shared clinical decision-making.

Date Released: 01/31/2020

  • For adults 65 years or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive PCV13 AND PPSV23:
  • Administer 1 dose of PCV13 first then give 1 dose of PPSV23 at least 1 year later.
  • Footnote

    Who Should Get The Vaccine

    Vaccinations

    People over age 65. As you age, your immune system doesnât work as well as it once did. Youâre more likely to have trouble fighting off a pneumonia infection. All adults over age 65 should get the vaccine.

    Those with weakened immune systems. Many diseases can cause your immune system to weaken, so itâs less able to fight off bugs like pneumonia.

    If you have heart disease, diabetes, emphysema, asthma, or COPD , youâre more likely to have a weakened immune system, which makes you more likely to get pneumonia.

    The same goes for people who receive chemotherapy, people who have had organ transplants, and people with HIV or AIDS.

    People who smoke. If youâve smoked for a long time, you could have damage to the small hairs that line the insides of your lungs and help filter out germs. When theyâre damaged, they arenât as good at stopping those bad germs.

    Heavy drinkers. If you drink too much alcohol, you may have a weakened immune system. Your white blood cells donât work as well as they do for people with a healthy immune system.

    People getting over surgery or a severe illness. If you were in the hospital ICU and needed help breathing with a ventilator, youâre at risk of getting pneumonia. The same is true if youâve just had major surgery or if youâre healing from a serious injury. When your immune system is weak because of illness or injury or because itâs helping you get better from surgery, you canât fight off germs as well as you normally can.

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    Common And Local Adverse Events

    Pneumococcal conjugate vaccine

    Studies of Pneu-C-13 vaccine indicated that irritability decreased appetite increased or decreased sleep and pain, swelling and redness at the injection site after the toddler dose and in older children, are common side effects. Low grade fever occurred in 20% to 30% or more of vaccine recipients. In adults over 50 years of age, the most commonly reported side effects included pain at the injection site, fatigue, headache and new onset of myalgia, with fever above 38°C occurring in approximately 3% of vaccine recipients.

    Pneumococcal polysaccharide vaccine

    Reactions to Pneu-P-23 vaccine are usually mild. Soreness, redness and swelling at the injection site occur in 30% to 60% of vaccine recipients and more commonly follow SC administration than IM administration. Occasionally, low grade fever may occur. Re-immunization of healthy adults less than 2 years after the initial dose is associated with increased injection site and systemic reactions. Studies have suggested that re-vaccination after an interval of at least 4 years is not associated with an increased incidence of adverse side effects. However, severe injection site reactions, including reports of injection site cellulitis and peripheral edema in the injected extremity, have been documented rarely with Pneu-P-23 vaccine in post-marketing surveillance, even with the first dose. Multiple re-vaccinations are not recommended refer to Booster doses and re-immunization.

    Who Should Not Get The Vaccine

    People should not get the vaccine if they have had a life threatening allergic reaction to a previous dose.

    Additionally, a person should not undergo vaccination if they have had an allergic reaction to medication containing diphtheria toxoid or an earlier form of the pneumonia vaccination .

    Lastly, people who are sick or have allergic reactions to any of the ingredients of the vaccine should talk to a doctor before getting the shot.

    A pneumonia shot will not reduce pneumonia. However, it helps prevent invasive pneumococcal diseases, such as meningitis, endocarditis, empyema, and bacteremia, which is when bacteria enter the bloodstream.

    Noninvasive pneumococcal disease includes sinusitis.

    There are two types of pneumonia shots available. Which type a person gets depends on their age, whether or not they smoke, and the presence of any underlying medical conditions.

    The two types are:

    • Pneumococcal conjugate vaccine : Healthcare providers recommend this vaccine for young children, people with certain underlying conditions, and some people over the age of 65 years.
    • Pneumococcal polysaccharide vaccine : Healthcare providers recommend this vaccine for anyone over 65 years of age, people with certain underlying conditions, and people who smoke.

    According to the

    • roughly 8 in 10 babies from invasive pneumococcal disease
    • 45 in 100 adults 65 years or older against pneumococcal pneumonia
    • 75 in 100 adults 65 years or older against invasive pneumococcal disease

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    Extended Pneumococcal Immunisation For High

    As part of the extended immunisation programme for high-risk groups, PCV13 and 23PPV are funded for eligible individuals, as shown in Table 16.3, Table 16.4 and Table 16.5. Because the recommended schedule depends on the age of the individual at diagnosis, the tables have been organised into age groups .

    The PCV13 and 23PPV funding restrictions are as follows. See Table 16.3, Table 16.4 and Table 16.5 for the eligible conditions and dosing requirements.

    PCV13

    All high-risk infants are recommended to receive at least three doses of a PCV vaccine, with at least one dose after 12 months of age. Change from PCV10 to PCV13 as soon as the infant is diagnosed as being at high risk.

    • Two doses of PCV13 are funded for high-risk children aged from 12 months and under 18 years who have previously received two or three doses of PCV10.
    • Up to four doses of PCV13 are funded for vaccination or re-vaccination of high-risk children aged under 5 years.
    • Up to four doses of PCV13 are funded for vaccination or re-vaccination of eligible individuals aged 5 years and older.

    23PPV

    1 dose of PCV13.b

    23PPV

    Give a maximum of 3 doses of 23PPV in a lifetime, a minimum of 5 years apart. The first 23PPV dose is given at least 8 weeks after PCV13, the 2nd a minimum of 5 years later, and the 3rd dose at age 65 years.

  • PCV13 is funded pre- or post-HSCT or chemotherapy. 23PPV is only funded post-HSCT or chemotherapy.
  • Tetanus Diphtheria And Pertussis

    Pneumococcal vaccine, helps protect you against pneumonia and meningitis.

    The tetanus, diphtheria, and pertussis vaccine combined is recommended if you have not received a tetanus shot in the last 10 years or have only had the tetanus and diphtheria combined vaccine and not the Tdap in the past.

    Tetanus is caused by a bacteria in soil, dirt and manure and can impair the nervous system. Diphtheria is caused by a bacteria that attaches to the lining of the respiratory system, which causes difficulty breathing and swallowing and can get into the bloodstream and damage the heart, kidneys and nerves. Pertussis can be a very serious disease, especially for vulnerable populations, such as infants, young children and older adults. Pertussis causes coughing fits due to the bacteria attaching to the lining of the upper respiratory system.

    The vaccine is greater than 95 percent effective in preventing tetanus and diphtheria and 70 percent effective in preventing pertussis. You can get this vaccine from your health care provider.

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