ACIP recommends PCV13 for all adults 65 and up

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Increased pneumococcus immunity is important

Dr. Dan Ouellette

Dr. Dan Ouellette, FCCP, comments: Every year in the fall, I recommend to my patients with respiratory disease that they receive the influenza vaccine. Often, they ask me "what about the pneumonia vaccine"? We then have a conversation about what the "pneumonia vaccine" is. I review their immunization record with them to try and figure out if they have received this vaccine before, and if so, when. This year, the situation is both complicated and clear in my patients over 65 years of age. It is more complicated because the 13-valent pneumococcal vaccine must be administered in addition to the 23-valent pneumococcal vaccine, with those patients who have not received the PCV23 having to receive both. It is clearer, because all of my older patients must receive the PCV13. It is better for my patients, because they will have increased immunity to the pneumococcus.

Dr. Ouellette is a specialist in pulmonary disease at Henry Ford Hospital in Detroit, Michigan.




All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

Adults 65 and older should routinely get PCV13 and PPSV23 vaccinations, says ACIP. © Micah Young /

Adults 65 and older should routinely get PCV13 and PPSV23 vaccinations, says ACIP.

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.

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