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Implementing Pneumococcal Vaccination in the Elderly and High-Risk Adults

Implementing Pneumococcal Vaccination in the Elderly and High-Risk Adults. Donald B. Middleton, MD Professor of Family Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Litjen (L.J) Tan, MS, PhD Chief Strategy Officer Immunization Action Coalition

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Implementing Pneumococcal Vaccination in the Elderly and High-Risk Adults

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  1. Implementing Pneumococcal Vaccination in the Elderly and High-Risk Adults

  2. Donald B. Middleton, MD Professor of Family Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Litjen(L.J) Tan, MS, PhD Chief Strategy Officer Immunization Action Coalition St. Paul, Minnesota

  3. Disclosures • Dr. Middleton has served on the vaccine advisory committees of Merck, Pfizer, GlaxoSmithKline, and SanofiPasteur • Dr. Tan has nothing to disclose

  4. Learning Objectives Upon completion of this activity, participants will be better able to: • Recognize the disease burden of pneumococcal disease among the elderly and high-risk adult populations • Identify strategies for increasing vaccination rates among the elderly and high-risk adult populations • Discuss the cost-effectiveness of pneumococcal vaccination

  5. Importance of Pneumococcal Vaccination • In 2015, 29,500 cases of invasive pneumococcal disease (IPD) and > 3,000 deaths were reported, with > 90% of these deaths occurring in people 65 and older1 • The ACIP recommends the use of two different pneumococcal vaccines, PCV13 and PPSV23, in adults1 • Pneumococcal vaccination of adults is tailored to different populations, depending upon age and the presence of different risk factors and comorbidities • It can prevent a wide range of disease conditions,2 including: • Sinusitis • Otitis media • Pneumonia • Bacteremia • Meningitis • Pyogenicarthritis • Osteomyelitis • Cellulitis • Peritonitis • And many other diseases 1. CDC 2015; 2. GBD Collaborators. Lancet. 2015;385(9963):117-171

  6. Elderly PopulationAge 65 Years and Older

  7. Burden of Pneumococcal Disease in the Elderly • Risk of IPD increases with age1 • Chronic illnesses are more common2 • Immune system is aging2 • Higher fatality rates2 • Community acquired pneumonia is burdensome • Estimated total cost (direct and indirect) = $5.0 billion3 • Only about 60% of people age 65 and older receive any pneumococcal vaccine4 • Healthy People 2020 goal for this population = 90% 1. CDC 2015; 2. Smith KJ, et al. Am J Prev Med. 2013;44(4):373-381; 3. McLaughlin JM, et al. J Prim Prev. 2015;36(4):259-273; 4. Williams WW, et al. MMWR Morb Mortal Wkly Rep. 2014;63(5):95-102

  8. ACIP Guidelines for Vaccinating Adults 65 Years of Age and Older Groups B and C: immunocompromised, chronic renal failure, nephrotic syndrome, asplenia, cerebrospinal fluid (CSF) leaks, cochlear implants CDC 2015 website

  9. High-Risk PopulationsAge 19 to 64 Years Old

  10. Factors That Increase the Risk of IPD • Alcohol abuse • Cancer • Chronic heart disease • Chronic liver disease and hepatic cirrhosis • Chronic lung disease • Chronic renal failure • Cigarette smoking • Cochlear implants • CSF leaks • Diabetes mellitus • Functional or anatomic asplenia • Immunocompromise • Nephrotic syndrome CDC. MMWR Morb Mortal Wkly Rep. 2012 Oct 12;61(40):816-819

  11. Burden of Pneumococcal Disease in Adults at High Risk • In 2015, only 23% of high-risk adults 19 to 64 years old received any pneumococcal vaccine1 • Healthy People 2020 goal = 60% • In 2009, 44%–63% of high-risk adults had IPD (excluding immunocompromised patients)2 • Many cases could be prevented by immunization with PCV13 and PPSV23 (42%–63% for those with an indication) according to disease serotype 1. Williams WW, et al. MMWR SurveillSumm. 2017;66(11):1-28; 2. Muhammad RD, et al. Clin Infect Dis. 2013;56(5):e59-e67

  12. ACIP Guidelines for Vaccinating 19- to 64-Year-Old Adults With Underlying Conditions CDC 2015 website

  13. Pneumococcal Vaccination of 19- to 64-Year-Old Adults “At Risk”* • Administer PPSV23 • When patient turns 65, give PCV13, waiting at least 1 year after he/she received PPSV23 • One year after giving PCV13, give PPSV23, waiting at least 5 years after he/she last received PPSV23 * Due to chronic heart or lung disease, diabetes mellitus, alcoholism, chronic liver disease, and/or smoking

  14. Pneumococcal Vaccination of 19- to 64-Year-Old Adults at “High Risk”* • Administer PCV13 • At least 8 weeks later, give PPSV23 • When patient turns 65, give another dose of PPSV23, waiting at least 5 years after he/she last received PPSV23 * Due to CSF leaks or cochlear implants

  15. Pneumococcal Vaccination of 19- to 64-Year-Old Adults at “Highest Risk”* • Administer PCV13 • At least 8 weeks later, give PPSV23 • At least 5 years later, give another dose of PPSV23 • When patient turns 65, give the final dose of PPSV23, waiting at least 5 years after the previous dose of PPSV23 * Due to congenital or acquired asplenia; sickle cell disease/other hemoglobinopathies; chronic renal failure; congenital or acquired immunodeficiencies; generalized malignancy; HIV infection; Hodgkin’s disease; iatrogenic immunosuppression(diseases requiring treatment with immunosuppressive therapy, including long-term systemic corticosteroids and radiation therapy); leukemia; lymphoma; multiple myeloma; nephroticsyndrome; and/or solid organ transplant

  16. Cost-Effectiveness • Hospital-treated pneumonia in the elderly cost more than $7 billion a year in 20101 • PCV13 vaccination of COPD patients aged 50 years and older is cost-effective versus giving PPSV232 • PCV13 vaccination could prevent an additional 182 deaths (using a 5-year modeling horizon) • Adding PCV13 to routine vaccinations in patients aged 65 and older is cost-effective3 • Economic studies also show pneumococcal vaccines are cost-effective in adults at risk 1. Thomas CP, et al. Chest 2012;142(4):973-981; 2. Rodríguez González-Moro JM, et al. ClinDrugInvestig. 2016;36(1):41-53; 3. Smith KJ, et al. Am J Prev Med. 2013;44(4):373-381

  17. Key Points • The ACIP has established specific recommendations for vaccination of adults 19 to 64 years of age who are at increased risk of invasive pneumococcal disease and other illnesses due to the existence of certain comorbiditiesand risk factors • Pneumococcal vaccines are cost-effective and have few contraindications • It is important to address identified barriers to pneumococcal vaccination in clinical practice to increase vaccination rates

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