Expect Changes to Prevnar 13 Recommendations for Healthy Seniors

You'll start to see LESS focus on giving Prevnar 13 to healthy seniors...due to changes in CDC guidelines expected this fall.

We're used to giving immunocompetent adults 65 and older Prevnar 13 followed by Pneumovax 23 one year later...based on 2014 recommendations.

The idea was to further decrease pneumococcal infection rates.

But it turns out that seniors are mainly protected from strains in Prevnar 13 by "herd immunity"...thanks to successful vaccination of kids.

Expect updated CDC recommendations to advise "shared clinical decision-making" with seniors when considering Prevnar 13. Be aware, your standing order may not change until the final guidelines are published.

Reassure that there aren't safety concerns with Prevnar 13. But there doesn't seem to be much benefit. Help healthy seniors decide about Prevnar 13 with our patient handout, Which Pneumonia Vaccine Do I Need?

Explain that Prevnar 13 prevents just 1 case of outpatient pneumonia for every 2,600 healthy seniors immunized per year.

And giving Prevnar 13 to healthy seniors only prevents 1 case of invasive pneumococcal disease for every 26,300 immunized per year.

Plus Prevnar 13 costs about $190/dose.

Focus on giving Pneumovax 23 to seniors 65 and older. It protects against 11 serotypes not covered by herd immunity from Prevnar 13.

For now, when healthy seniors choose to get both vaccines, continue to give Prevnar 13 first...then Pneumovax 23 one year later. Medicare Part B still covers both if they're spaced at least one year apart.

Advise that immunocompromised adults (chronic renal failure, etc) of any age get both vaccines. Give Prevnar 13, then Pneumovax 23 at least 8 weeks later...to limit unprotected time in these more vulnerable patients.

And continue to recommend Pneumovax 23 for adults UNDER 65 who smoke or have chronic conditions...and Prevnar 13 as a routine vaccine in kids.

Use our Pneumococcal Vaccination in Adults: Who Gets What and When? chart to find out what to recommend for your patient.

Key References

  • www.cdc.gov/vaccines/acip/meetings/slides-2019-06.html (08-16-19)
  • MMWR Morb Mortal Wkly Rep 2015;64(34):944-7
  • MMWR Morb Mortal Wkly Rep 2014;63(37):822-5
  • Medication pricing by Elsevier, accessed Aug 2019
Pharmacist's Letter. September 2019, No. 350901

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