Pneumococcal Polysaccharide Vaccine (PPSV23) Recommendations

1. Pneumococcal Polysaccharide Vaccine (PPSV23) Recommendations • Unvaccinated adults 65 years of age and older • Adults 19 through 64 years of age with chronic conditions • cardiovascular disease • pulmonary disease (including asthma) • diabetes mellitus • alcoholism • chronic liver disease • Cigarette smokers

2. PPSV23 Recommendations for Adults at Highest Risk of Invasive Pneumococcal Disease (IPD) • Adults should receive two doses of PPSV23 separated by at least 5 years • functional or anatomic asplenia • cerebrospinal fluid (CSF) leak • cochlear implant • immunocompromised for any reason, including disease and immunosuppressive drugs or therapy

3. PPSV23 Revaccination • Persons who received one or two doses of PPSV23 before age 65 years for any indication should receive another dose at age 65 or older if at least 5 years have passed since previous dose • Those who receive their first dose of PPSV23 at or after age 65 do not need any additional doses

4. Pneumococcal Conjugate Vaccine (PCV13) for Adults • On December 30, 2011, PCV13 (Prevnar13, Pfizer) was approved for use among adults 50 years of age and older • FDA approved expanded age indication through the Accelerated Approval Pathway

5. Pneumococcal Conjugate Vaccine (PCV13) for Adults • Immunogenicity of PCV13 was found to be non-inferior to PPSV23 • Indication • prevention of pneumococcal disease, including pneumonia and invasive disease caused by the 13 Streptococcus pneumoniaeserotypes in PCV13

6. Incidence of IPD in adults aged 18--64 years with selected underlying conditions, United States, 2009 20 fold increased risk 3-7 fold increased risk

7. ACIP Recommendations June 2012 PCV13 for Immunocompromised Adults • Benefits outweigh any risks • Indirect effects of PCV13 use in children not likely to eliminate IPD due to PCV13 serotypes in adults • PCV13 use alone may not provide adequate coverage • Combined use of PCV13 and PPSV23 more effective than either vaccine alone

8. Pneumococcal Vaccine-Naïve Immunocompromised Adults • Adults 19 through 64 years of age with immunocompromising conditions, functional or anatomic asplenia, CSF leak, or a cochlear implant who are vaccine naïve, should receive a single dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later • A second dose of PPSV23 is recommended 5 years after the first dose of PPSV23

9. Pneumococcal Vaccine-Naïve Immunocompromised Adults • A third and final dose of PPSV23 is recommended at 65 years of age or older as long as 5 years have elapsed since the second dose of PPSV23

10. Pneumococcal Vaccine-Naïve Immunocompromised Adults PCV13 + PPSV23 + PPSV23 + PPSV23 At least 8 weeks apart At 65 years or later if 5 years have elapsed since the last dose At least 5 years apart

11. PCV13 for Adults Previously Vaccinated with PPSV23 • Adults with immunocompromising conditions, functional or anatomic asplenia, CSF leak, or a cochlear implant previously vaccinated with PPSV23 should receive PCV13 one or more years after the last PPSV23 dose • For those that require additional doses of PPSV23, the first dose should be administered no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23

12. PCV13 for Adults Previously Vaccinated with PPSV23 • 40-year-old male with asplenia received PPSV23 three years ago • Administer: • a dose of PCV13 today (more than 1 year since PPSV23) • a 2nd PPSV23 in 2 years (5 years after PPSV23 and at least 8 weeks after PCV13) • a final dose of PPSV23 at 65 years of age or older