Pneumococcal vaccine series uptake low despite ACIP recommendation

Two years after the CDC’s Advisory Committee on Immunization Practices recommended routine use of a two-vaccine series to prevent pneumococcal infection in seniors, uptake of the series remained below 20% in 2016, according to researchers.

Uptake of the single vaccine that the ACIP previously recommended was below 50%, they wrote in MMWR. The low numbers mean clinicians should be more vigilant in keeping older patients up to date on vaccinations.

“To reduce the incidence of pneumococcal disease, providers should ensure that older adults initiate and complete the recommended pneumococcal vaccination series,” researcher Carla L. Black, PhD, an epidemiologist with the CDC’s National Center for Immunization and Respiratory Diseases, and colleagues wrote.

In August 2014, ACIP members voted to recommend routine use in patients aged 65 years and older of both Prevnar 13 (13-valent pneumococcal conjugate vaccine [PCV13], Pfizer) and Pneumovax 23 (23-valent pneumococcal polysaccharide vaccine [PPSV23], Merck). The committee had previously recommended a single dose of PPSV23 for that population.

However, the CDC found that about 20% to 25% of invasive pneumococcal disease (IPD) cases and 10% of community-acquired pneumonia cases in people aged 65 years and older result from serotypes targeted by PCV13.

The agency estimated that adding it to seniors’ continuum of care would “prevent 230 cases of IPD and approximately 12,000 cases of community-acquired pneumonia over the lifetime of a single cohort of persons aged 65 years in the United States,” the researchers said.

To assess uptake of the two-vaccine series, they counted claims for PCV13 and PPSV23 submitted to CMS among people aged 65 years and older who were enrolled in Medicare Parts A and B from Sept. 19, 2009, to Sept. 18, 2016.

As of the latter date, they said, 43.2% had received at least one dose of PPSV23, 31.5% had received at least one dose of PCV13 and 18.3% had received both vaccines. By then, claims for at least one pneumococcal vaccine of any kind had risen to 56.4% from 40% a full 6 years earlier.

Uptake of all pneumococcal vaccines, as well as the two-vaccine series, was highest among patients who were white, older, or had chronic or immunocompromising conditions, the researchers said.

Uptake of both PPSV23 and PCV13 ranged from 6.8% among Hispanics to 19.5% among whites, and from 11% among patients aged 65 to 69 years to 24.3% among patients aged 80 to 84 years.

There was also a wide gap in uptake of the two vaccines between patients with and without immunocompromising conditions (21.8% and 12.2%, respectively), and between those with and without chronic medical conditions (19.9% and 9.8%, respectively).

The researchers suggested that clinicians could increase immunization among older Americans with guidance from the National Vaccine Advisory Committee.

“Implementation of the National Vaccine Advisory Committee’s standards for adult immunization practice to assess vaccination status at every patient encounter, recommend needed vaccines and administer vaccination or refer to a vaccinating provider might help increase pneumococcal vaccination coverage and reduce the risk for pneumonia and invasive pneumococcal disease among older adults,” they wrote. – by Joe Green

References:

Black CL, et al. MMWR Morb Mortal Wkly Rep. 2017;66:728-733.

Centers for Disease Control and Prevention. Standards for Adult Immunization Practice. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html. Accessed July 17, 2017.

Disclosure: The researchers report no relevant financial disclosures.