A 65-year-old woman is in your clinic for a regular follow up for her mild COPD. She was told by her friend to ask about the pneumonia vaccine because “there’s a new one out”. She mentions to you that she remembers being vaccinated with the PPSV23 at age 63.
Which of the following best describes the CDC recommended approach to vaccinating this patient?
A. She should wait 5 years to be revaccinated with the PPSV23
B. She was already vaccinated and does not need to be revaccinated
C. She should receive the PCV13 vaccine now and the PPSV23 again within 6-12 months
D. She should receive the PCV13 vaccine at age 68 and be revaccinated with PPSV23 within 6-12 months
E. She should receive the PCV13 vaccine now and does not need revaccination with PPSV23
Correct answer:D – She should receive the PCV13 vaccine at age 68 and be revaccinated with PPSV23 within 6-12 months
Key Point: All adults aged ≥65 years should receive the PCV13 vaccine and the PPSV23 vaccine to avoid invasive pneumococcal disease, but the timing is important.
Discussion:The PCV13 vaccine was approved by the FDA in 2011 as part of its accelerated approval pathway program based on 2 large randomized controlled trials. The PCV13 vaccine’s protection shares 12 serotypes with the PPSV23 vaccine and an additional unique serotype (6A). One of the RCTs showed either noninferiority (4 shared serotypes) or superiority (8 shared serotypes plus serotype 6A) by opsonophagocytic activity titers 1 month after vaccination.
The following is from the CDC:
Both PCV13 and PPSV23 should be administered routinely in series to all adults aged ≥65 years.
Pneumococcal vaccine-naïve persons:
Adults aged ≥65 years who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The dose of PPSV23 should be given 6–12 months after a dose of PCV13. If PPSV23 cannot be given during this time window, the dose of PPSV23 should be given during the next visit. The two vaccines should not be coadministered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.
Previous vaccination with PPSV23:
Adults aged ≥65 years who have previously received ≥1 doses of PPSV23 also should receive a dose of PCV13 if they have not yet received it. A dose of PCV13 should be given ≥1 year after receipt of the most recent PPSV23 dose. For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6–12 months after PCV13 and ≥5 years after the most recent dose of PPSV23.
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