Saturday, July 06, 2013

Using Pneumococcal Vaccine in Adults - How to use both PCV 13 & PPV 23?

There is a 'Pediatric' Pneumonia Conjugate Vaccine (PCV) & an 'Adult' Pneumococcal Polysaccharide vaccine (PPV). Previously we were using PCV in children below 5 years, and the "Adult vaccine' in older kids / adults as needed. 
However, since 2011 PCV is also being recommended (in the US) for adults above 65 years, and in people who are immunocompromised even between 19-65 years.
Now the same recommendations have happened in India for older adults too.
Hence we need to know how to use the pediatric vaccine & the adult vaccine in older adults & high risk patients.
Here is what the ACIP says
ACIP Recommendations for PCV13 and PPSV23 Use
Adults with specified immunocompromising conditions who are eligible for pneumococcal vaccine should be vaccinated with PCV13 during their next pneumococcal vaccination opportunity.
Pneumococcal vaccine-na├»ve persons. ACIP recommends that adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later (Table). Subsequent doses of PPSV23 should follow current PPSV23 recommendations for adults at high risk. Specifically, a second PPSV23 dose is recommended 5 years after the first PPSV23 dose for persons aged 19–64 years with functional or anatomic asplenia and for persons with immunocompromising conditions. Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years, or later if at least 5 years have elapsed since their previous PPSV23 dose.
Previous vaccination with PPSV23. Adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, who previously have received ≥1 doses of PPSV23 should be given a PCV13 dose ≥1 year after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.



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