Date post: | 13-Jan-2016 |
Category: |
Documents |
Upload: | dulcie-mccormick |
View: | 218 times |
Download: | 1 times |
Chris Knefelkamp, PharmD
PGY2 Internal Medicine Resident
Richard L. Roudebush VA Medical Center
September 17, 2015
A SHOT IN THE DARK: PNEUMOCOCCAL PNEUMONIA
VACCINE ADMINISTRATION
This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.
OBJECTIVES
• Describe the immunological responses of Prevnar and Pneumovax
• List the proper timeline for pneumococcal vaccine administration based on age and comorbidities
• Identify the laws governing pharmacist administration of pneumococcal vaccines
• About 900,000 Americans get pneumococcal pneumonia each year with a 5-7% mortality rate
• 400,000 hospitalizations annually• 90% of invasive pneumococcal disease cases in adults• >95% pneumococcal deaths occur in adults• Combination immunization therapy of
Prevnar and Pneumovax
• Schedules based on:• Age• Prior vaccination status• Immunocompetency
BACKGROUND: PNEUMOCOCCAL DISEASE
CDC. Pneumococcal Disease. Available at: http://www.cdc.gov/pneumococcal/about/facts.html. Accessed July 28, 2015.
PRODUCTS
Vaccine Attenuation TypeUnique
SerotypesCommon Serotypes Cost*
Pneumovax 23 Inactivated Polysaccharide 2,8,9N, 10A,11A,12F, 15B, 17F, 20, 22F, 33F
1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F
$72.38
Prevnar 13 Inactivated Conjugated 6A 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F
$152.01
Prevnar 13 [package insert]. New York, NY: Pfizer Inc; 2015.
Pneumovax 23 [package insert]. Kenilworth, NJ: Merck and Co; 2015.
*AWP
Principles of vaccination. The Pink Book: Course Textbook. 12th Ed. http://www.nature.com/nri/journal/v9/n3/fig_tab/nri2494_F1.html
Principles of vaccination. The Pink Book: Course Textbook. 12th Ed. http://www.nature.com/nri/journal/v9/n3/fig_tab/nri2494_F1.html
• All age groups• Lateral thigh• Deltoid
• Intramuscular OR subcutaneous
• Infants • Lateral thigh
• Toddlers, Children, Adults • Deltoid
• DO NOT administerin gluteal areas
• Intramuscular
ADMINISTRATION TECHNIQUE
Prevnar Pneumovax
Prevnar 13 [package insert]. New York, NY: Pfizer Inc; 2015.
Pneumovax 23 [package insert]. Kenilworth, NJ: Merck and Co; 2015.
TIMELINE OF ADMINISTRATION
Age Groups Underlying Conditions PCV13 → PPSV23
PPSV23 → PCV13
24–71 mo • Immunocompetent with underlying chronic conditions
• Functional or anatomic asplenia• Immunocompromised
≥8 wks
≥8 wks
6–18 y • High-risk immunocompetent (cerebrospinal fluid leaks, cochlear implants)
• Functional or anatomic asplenia• Immunocompromised
≥8 wks
≥8 wks
≥ 19 y • High-risk immunocompetent (cerebrospinal fluid leaks, cochlear implants)
• Functional or anatomic asplenia• Immunocompromised
≥8 wks
≥1 y
≥ 65 y • N/A ≥1 y ≥1 y
Foster, SL. American Pharmacists Association. 2011. http://www.pharmacist.com/updates-vaccine-recommendations-focus-acips-june-meeting
VACCINE – NAÏVE > 65 YEARS
Prevnar > 1 Year Pneumovax
Tomczyk S, et al. MMWR Morbid Mortal Wkly Rep 2014;63:822-825.
PREVIOUSLY RECEIVED PNEUMOVAX
Received Pneumovax at age > 65
> 1 year Prevnar
Tomczyk S, et al. MMWR Morbid Mortal Wkly Rep 2014;63:822-825.
PREVIOUSLY RECEIVED PNEUMOVAX
Received Pneumovax at
age < 65>1 year Prevnar at age
> 65
> 1 yearPneumovax 5 years
Tomczyk S, et al. MMWR Morbid Mortal Wkly Rep 2014;63:822-825.
IMMUNOCOMPROMISING CONDITIONS
• Receive BOTH Prevnar and Pneumovax (with repeat)• Asplenia• Hemoglobinopathy (Sickle Cell)• Complement deficiency• B or T Cell deficiency• Cancer• HIV• Chronic renal failure or nephrotic syndrome• Organ transplant• Iatrogenic immunosuppression (Chemotherapy, radiation
therapy, systemic steroids for 14+ days)Centers for Disease Control and Prevention. 2012:61;816-819.
OTHER CHRONIC CONDITIONS (<65 YO)Risk group Underlying
medical conditionPCV13 PPSV23
Recommended Recommended Revaccination 5 yrs after first dose
Immunocompetent persons
Chronic heart disease
✔
Chronic lung disease
✔
Diabetes mellitus ✔
Cerebrospinal fluid leak
✔ ✔
Cochlear implant ✔ ✔
Alcoholism ✔
Chronic liver disease, cirrhosis
✔
Cigarette smoking (age 19+)
✔
Heart disease – CHF and CMLung disease – COPD, emphysema, asthma (age 19+) Centers for Disease Control and Prevention. 2012:61;816-819 .
TIMELINE PEARLS
• DO NOT administer together• Previously 6-12 month recommended interval PCV13PPSV23
• No data for shorter intervals• No immunologic differences between 6 and 12 months• Higher incidence of adverse effects with shorter (6 month) interval
• If Pneumovax is given at a shorter interval than 12 months, no need to repeat it
• Administer even if had previous pneumococcal pneumonia infection
• CMS will only cover 2nd vaccine if 1 year has passed• May be co-administered with Influenza vaccine
Foster, SL. American Pharmacists Association. 2011. http://www.pharmacist.com/updates-vaccine-recommendations-focus-acips-june-meeting
Chris Knefelkamp, PharmD
PGY2 Internal Medicine Resident
Richard L. Roudebush VA Medical Center
September 17, 2015
A SHOT IN THE DARK: PNEUMOCOCCAL PNEUMONIA
VACCINE ADMINISTRATION