Which patients are eligible for the Pneumovax and/or Prevnar vaccines

Posted on May 19, 2020 by Kelly Dong

Summary

Prevnar 13 is routinely given to infants while Pneumovax 23 is routinely given to seniors over the age of 65 and anyone living in residential or assisted living homes. However, patients may be eligible for a dose of Prevnar 13 or Pneumovax 23 if they have any of the listed high-risk conditions. When considering the eligibility criteria, it is important to consider conditions where patients should not be receiving these vaccinations, such as anaphylactic hypersensitivity, and precautionary measures.

I.   Prevnar 13 (Pneumococcal Conjugate Vaccine) [1,2,3]

  • Routine immunization in infants (3 doses)
PCV 13 Vaccine Child’s Age at Immunization
1st dose 2 months
2nd dose 4 months
3rd dose 12 months
  • Extra dose of the vaccine is given at 6 months to children who have:
    • No spleen, or a spleen that is not working properly
    • Sickle-cell disease
    • An immune system weakened by disease or medical treatment
    • Chronic liver disease, including cirrhosis, chronic hepatitis B or hepatitis C
    • Chronic kidney, heart or lung disease
    • An islet cell or solid organ transplant, or a cochlear (inner ear) implant, or are waiting for one
    • Had a stem cell transplant
    • A chronic neurological condition that makes it hard to clear fluids from the mouth or throat
    • Diabetes, cystic fibrosis or a chronic cerebrospinal fluid leak
  • High risk patients aged 5 years and older with the following medication conditions may receive 1 dose of the vaccine:
    • Children 5 to 18 years of age with no spleen, or a spleen that is not working properly
    • Adults and children 5 years of age and older with HIV infection
    • Stem cell transplant recipients (receive 3-4 doses rather than 1 depending on age) [4]
  • One dose recommended by the National Advisory Committee on Immunization but not provided free in BC
    • Good evidence: Children up to 18 years of age (inclusive) with asthma which required medical attention in the past 12 months.
    • Fair evidence: adults with
      • Asplenia (anatomical or functional) 
      • Sickle cell disease or other hemoglobinopathies 
      • Congenital immunodeficiencies involving any part of the immune system, including B-lymphocyte (humoral) immunity, T-lymphocyte (cell) mediated immunity, complement system (properdin or factor D deficiencies), or phagocytic functions 
      • Immunosuppressive therapy including use of long term corticosteroids, chemotherapy, radiation therapy, post-organ-transplant therapy, biologic and nonbiologic immunosuppressive therapies for rheumatologic and other inflammatory diseases. 
      • Malignant neoplasms including leukemia and lymphoma 
      • Solid organ or islet cell transplant (candidate or recipient)
  • Who should not get the vaccine
    • Life-threatening reaction to a previous dose of pneumococcal vaccine or any component of the vaccine
    • No need to delay getting immunized because of a cold or another mild illness
    • Precautions: If PPV23 has already been administered, PCV13 should be administered at least one year later

II.   Pneumovax 23 (Pneumococcal Polysaccharide Vaccine) [1,5,6]

  • Seniors 65 years and older; and
  • Residents of any age living in residential care or assisted living facilities
  • Provided free to anyone who is 2 years of age and older with the following conditions:
    • No spleen, or a spleen that is not working properly;
    • Sickle-cell disease;
    • An immune systems weakened by disease or medical treatment;
    • Chronic liver disease, including cirrhosis, chronic hepatitis B or hepatitis C;
    • Chronic kidney disease;
    • Chronic heart or lung disease;
    • An islet cell or solid organ transplant, or a cochlear (inner ear) implant, or those who are waiting for one;
    • A stem cell transplant;
    • Diabetes, cystic fibrosis, or a chronic cerebrospinal fluid leak;
    • An alcohol dependency;
    • Homeless persons; and
    • Users of illicit drugs, especially those who smoke crack cocaine.
  • A once-only revaccination should be offered 5 years after the initial immunization to those who have:
    • Anatomic or functional asplenia
    • Sickle cell disease
    • Immunosuppression related to disease (e.g., HIV, lymphoma, Hodgkin’s, multiple
    • myeloma) or therapy (e.g., high dose, systemic steroids)
    • Congenital immunodeficiency states (as above)
    • Chronic kidney disease
    • Chronic liver disease including cirrhosis, chronic hepatitis B, and hepatitis C
    • Solid organ or islet cell transplant (candidate or recipient)
  • Who should not get the pneumococcal polysaccharide vaccine
    • Life-threatening reaction to a previous dose of pneumococcal vaccine or any component of the vaccine
    • Children under 2 years of age
    • No need to delay getting immunized because of a cold or another mild illness
    • Precautions:
      • Pneumococcal vaccination should be administered at least 2 weeks prior to the initiation of immunosuppressive therapy.
      • Adverse reaction may intensify if revaccination occurs within 2 years

III.   Dosing Considerations [6]

When both Prevnar 13 and Pneumovax 23 are recommended, the age appropriate Prevnar 13 series should be administered first, followed at least 8 weeks later by Pneumovax 23. If Pneumovax 23 has already been administered, Prevnar 13 should be administered at least one year later.

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. BC Centre for Disease Control. Vaccines in BC [Internet]. BC Centre for Disease Control. [cited 15 May 2020]. Available from: http://www.bccdc.ca/health-professionals/clinical-resources/vaccines-in-bc
  2. HealthLinkBC. Pneumococcal Conjugate (PCV 13) Vaccine [Internet]. HealthLinkBC. Jul 2017 [cited 15 May 2020]. Available from: https://www.healthlinkbc.ca/healthlinkbc-files/pcv-13-vaccine
  3. BC Centre for Disease Control. Pneumococcal Conjugate Vaccine PREVNAR® 13 [Internet]. BC Centre for Disease Control. Aug 2018 [cited 15 May 2020]. Available from: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/Part4/PCV.pdf
  4. BC Centre for Disease Control. Hematopoietic Stem Cell Transplantation (HSCT) [Internet].  BC Centre for Disease Control. Aug 2018 [cited 15 May 2020]. Available from: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/Part2/HSCT.pdf
  5. HealthLinkBC. Pneumococcal Polysaccharide Vaccine [Internet]. HealthLinkBC. Mar 2017 [cited 15 May 2020]. Available from: https://www.healthlinkbc.ca/healthlinkbc-files/pneumococcal-polysaccharide-vaccine
  6. BC Centre for Disease Control. Pneumococcal Polysaccharide Vaccine PNEUMOVAX®23 [Internet]. BC Centre for Disease Control. Oct 2018 [cited 15 May 2020]. Available from: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/Part4/PPV23.pdf

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.