ACIP 2019

Background

In 2014, the ACIP recommended routine use of PCV13 among adults aged ≥65 years.¹ As per this recommendation, both PCV13 and PPSV23 should be routinely administered in series to all adults aged ≥65 years.¹ The ACIP recommendations for the use of PCV13 (high-risk) in adults aged ≥50 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak or cochlear implants remain unchanged.²

The ACIP recommendations were amended in 2015 to simplify the spacing between PCV13 and PPSV23 in adults aged >65 years.³ The recommendation states that the recommended interval for adults receiving PCV13 and PPSV23 is to be at least 1 year apart, regardless of sequence. In summary, this means that PCV13 is administered first, followed by PPSV23, with a gap of at least 1 year between the two. If an adult above 65 years of age received PPSV23, they will receive PCV13 after 1 year as the older recommendation. The recommended sequence and spacing of PCV13 and PPSV23 in adults aged >65 years is presented in the figure given below.^3,4

Sequence and Spacing of PCV13 and PPSV23 in Adults Aged >65 Years³

Adapted from Kobayashi M, et al. 2015.

The ACIP 2019 guidelines recommend PCV13 for all adults aged ≥65 years based on shared clinical decision-making. This group includes those adults aged ≥65 years who do not have CSF leak, immunocompromising conditions or cochlear implant.⁴

When the vaccine providers and patients engage in shared clinical decision-making regarding the use of PCV13 vaccine in adults ≥65 years, they may consider to include the risk for pneumococcal disease for that person resulting from underlying medical conditions or the individual patient’s risk for exposure to PCV13 serotypes. The 2019 ACIP recommendations for the use of PCV13 and PPSV23 vaccines in adults aged 19 to 64 and ≥65 years are depicted in the table below.⁴

Conclusion

In summary, the ACIP recommends considering regularly offering PCV13 to:

•  Patients aged ≥65 years who have not previously received PCV13

•  Persons residing in nursing homes or other long-term care facilities

•  Persons residing in settings with low paediatric PCV13 uptake

•  Persons traveling to settings with no paediatric PCV13 programme

•  Patients aged ≥65 with chronic heart, lung or liver disease, diabetes or alcoholism, and those who smoke cigarettes or who have more than 1 chronic medical condition

According to the recent 2019 ACIP recommendations, shared clinical decision-making for PCV13 use for those persons aged ≥65 years is recommended, who have not received PCV13 previously and do not have CSF leak, immunocompromising condition or cochlear implant.⁴

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