According to published research, there are two periods in our lives when our immune systems are particularly weak: as growing babies and aging seniors. For that reason, there are a few immunizations that the Centers for Disease Control and Prevention (CDC) recommends for both the youngest and oldest members of our society — among them, pneumococcal vaccination.
With children, uptake for pneumococcal vaccination is high, with the CDC reporting that 92% of children have received at least three doses. But among seniors 65 years of age or older, reports from CDC researchers show that vaccination rates are below the previous Healthy People 2020 target of 90% uptake.
Oftentimes, the key to uptake among patients is understanding. With pneumococcal disease, it’s important for providers to clearly communicate which diseases pneumococcal vaccines protect against, and which vaccines (between Prevnar 13® and Pneumovax 23) are recommended for which populations.
It’s not just about pneumonia
According to the CDC, pneumococcal disease is the broader name for any infection that stems from the pneumococcus bacteria. The most commonly known infection resulting from pneumococcus bacteria is pneumonia (infection of the lungs). But pneumococcus bacteria are also the culprit of ear and sinus infections. More seriously, meningitis (infection of the brain and spinal cord tissue) and bloodstream infections can occur, both of which the CDC categorizes as invasive and severe. It is these lung, ear, sinus, brain, and blood infections that pneumococcal vaccines help to protect against.
Pneumococcal vaccines and current recommendations
According to the College of Physicians of Philadelphia’s History of Vaccines, vaccines protecting against pneumococcal disease have been around for more than 40 years. First, Merck created a vaccine that protected against 14 different strains of the disease for a variety of populations, which later evolved to 23-strain protection that we now know as Pneumovax 23.
In 2000, Pfizer was licensed for PCV7 (the original Prevnar), which the CDC recommended for children to protect against seven disease strains. In 2010, Prevnar 13® was authorized and recommended as a replacement for PCV7, given its protection against six additional strains.
So where do things stand today, and which vaccine is recommended for whom? As of February 2021, below are some of the recommendations for the Prevnar 13® and Pneumovax 23.
Prevnar 13®
Newborns: In short, the CDC recommends Prevnar 13® for routine childhood vaccination. It is a four-dose series to be given to newborns at ages two months, four months, six months, and 12-15 months.
Toddlers catching up: Between two and five years of age, any children missing doses of the recommended four-dose series can receive one dose of Prevnar 13® to catch up.
High-risk children and teens: For patients between two and 18 years of age, particular health conditions, such as chronic heart disease, sickle cell, transplants or implants, or cancer, put them at even higher risk of contracting pneumococcal diseases. For some of these patients, Pneumovax 23 may be recommended in addition to Prevnar 13®.
The complete list of high-risk health conditions and Prevnar 13® recommendations is listed on the CDC’s website.
Pneumovax 23
Seniors 65 years of age and older: As of 2021, Advisory Committee on Immunization Practices (ACIP) recommends that adults aged 65 or older should receive one dose of Pneumovax 23. This applies to seniors who may have already had a dose of Pneumovax 23 before age 65; these two doses should be at least five years apart.
Shared decision-making: If a senior is not immunocompromised, the patient and provider can discuss together whether or not the patient takes Prevnar 13® or Pneumovax 23 first. If Prevnar 13® is chosen, Pneumovax 23 is still recommended one year later.
High-risk seniors: For seniors that are immunocompromised, both Prevnar 13® and Pneumovax 23 are recommended.
The full outline of the recommendations for Pneumovax 23 can be found on the CDC’s website.
What providers can do to increase uptake
The best thing that providers can do to help close the gaps between current and desired uptake rates for any immunization is to provide a clear, specific recommendation to patients for the vaccine.
But particularly with pneumococcal vaccination among seniors and high-risk patients, research shows that there are in-office patient visit opportunities that could be better utilized. A study from researchers at the University of Florida revealed that, on average, there were 5.15 healthcare visits at which a pneumococcal vaccination could have been administered to a senior patient but was not. For high-risk patients between 18-64 years old, there were 4.83 missed opportunities.
In the United States, pneumococcal pneumonia causes an estimated 150,000 hospitalizations each year. For our most vulnerable populations, Prevnar 13® and Pneumovax 23 can help prevent hospitalizations and severe illnesses. But public understanding, driven by providers, of the differences and interplays between these two vaccines is key to increasing uptake of pneumococcal immunization and keeping our young and old safe and healthy.
As of January 1, 2021, Atlantic Health Partners has Prevnar 13® available for our members. Learn more.