Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices

Matanock, Almea; Lee, Grace; Gierke, Ryan; Kobayashi, Miwako; Leidner, Andrew J.; Pilishvili, Tamara

doi:10.15585/mmwr.mm6846a5

Cited by 290 publications

(307 citation statements)

References 18 publications

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“…Based on our findings, it is similarly reasonable to require preoperative vaccination against seasonal influenza for all patients before elective CABG. Current United States Centers for Disease Control and Prevention guidelines recommend immunization against S. pneumoniae in all patients greater than 65 years old and among immunocompetent patients aged 19 to 64 with the following underlying conditions: (a) alcoholism; (b) chronic heart disease including congestive heart failure and cardiomyopathy; (c) chronic liver disease; (d) chronic lung disease including chronic obstructive pulmonary disease, emphysema, and asthma; (e) cigarette smoking; and (f) diabetes mellitus 15 . As the majority of patients referred for CABG have at least one or more of the aforementioned medical conditions, preoperative immunization with the 13‐valent pneumococcal conjugate vaccine (PCV13) or the 23‐valent pneumococcal polysaccharide vaccine (PPSV23) according to published guidelines should be recommended.…”

Section: Discussionmentioning

confidence: 99%

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

et al. 2020

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Background The development of postoperative pneumonia following cardiac surgery is associated with significant morbidity and mortality. However, seasonal variation as a risk factor for the development of postoperative pneumonia remains to be investigated. We sought to investigate whether patients undergoing coronary artery bypass grafting (CABG) during “flu season” (Fall and Winter months) at increased risk of postoperative pneumonia. Materials and Methods A retrospective cohort study of patients undergoing CABG in the National Inpatient Sample between 2005 and 2015 was completed. Concomitant diagnosis of pneumonia was defined as the primary outcome. Secondary outcomes were defined to include pneumonia secondary to several known pathogens. Outcomes with significant differences between Fall/Winter and Spring/Summer groups were further analyzed with additive time series decomposition. Odds ratios were generated and adjusted for age, sex, elective status, and 29 other Agency for Healthcare Research and Quality comorbidity measures. Results A total of 238 757 and 277 941 patients undergoing CABG during Fall/Winter and Spring/Summer, respectively, were identified. A significantly increased risk of postoperative pneumonia (adjusted odds ratio [aOR] = 1.15) and infection with influenza (aOR = 4.08), Haemophilus influenzae (aOR = 1.40), and Streptococcus pneumoniae (aOR = 1.47) was observed among patients receiving CABG in Q1 (January‐March) compared to Q3 (July‐September). Conclusions There is a strong seasonality in the incidence of postoperative pneumonia after CABG which may persist across other cardiothoracic surgeries. In addition to optimizing infection control and perioperative care, cardiac surgeons should consider preoperative vaccination against seasonal influenza, H. influenzae, and S. pneumoniae to improve outcomes among high‐risk patients.

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Section: Discussionmentioning

confidence: 99%

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

et al. 2020

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“…Therefore, the results of this clinical and economic model could have important implications for public health and could potentially underestimate the complete value of a program including PCV13. These findings are relevant in light of new Advisory Committee on Immunization Practices (ACIP) guidance for PCV13 based on shared clinical decision-making among adults 65 years or older who do not have an immunocompromising condition and who have not previously received PCV13 should receive a dose of PPSV23 [20].…”

Section: Discussionmentioning

confidence: 97%

Estimating the Clinical and Economic Impact of Switching from the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) to the 10-Valent Pneumococcal Conjugate Vaccine (PCV10) in Italy

et al. 2020

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Background: Invasive and non-invasive pneumococcal diseases are significant health and economic burdens, especially in children and the elderly. Italy included the 7-valent (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the National Immunization Program in 2007 and 2010, respectively, allowing a dramatic reduction in the burden of pneumococcal disease. In the era of budget constraints, decision-makers may consider switching from the higher-valent, more costly PCV13, to the lower-cost PCV10. This study estimated the potential public health and economic impact of changing vaccine programs from PCV13 to PCV10 in Italy. Methods: A decision-analytic forecasting model estimated the impact of PCV programs. Real-world surveillance data were used to forecast serotype distribution and disease incidence among children and the elderly over a specified 5-year time horizon. Costs and outcomes included estimates of cases and deaths avoided, quality-adjusted life years (QALYs) gained, and total costs from a payer perspective, discounted at an assumed rate of 3.0%, and robustness validated through several scenarios and sensitivity analyses. Results: A switch from PCV13 to PCV10 would increase invasive pneumococcal disease (IPD) cases by 59.3% (4317 cases) over a 5-year horizon, primarily due to serotypes 3 and 19A. Pneumonia increased by 8.3% and acute otitis media (AOM) by 96.1%. Maintaining a PCV13 program would prevent a total incremental 531,435 disease cases (1.02M over a 10-year time horizon) and 641 deaths due to invasive pneumococcal disease (IPD), with €23,642 per QALY gained over 5 years versus PCV10. One-way and probabilistic sensitivity analyses showed that a PCV13-based program remained cost-effective in 99.7% of the simulations in Italy as parameters varied within their plausible range; percent vaccinated had the most impact. Conclusions: Maintaining the PCV13 strategy would provide substantial public health and economic benefits in Italy and is cost-effective. Switching from PCV13 to PCV10 would increase the incidence of pneumococcal disease primarily linked to re-emergence of serotypes 3 and 19A.

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“…With lack of provincial funding, PCV13 uptake in adults has been low to date. Recently, both NACI and the Advisory Committee on Immunisation Practices in the USA cited a high economic cost and minimal public health benefit of PCV13 due to the low remaining disease burden of PCV13 serotypes in adults aged ≥65 years 1 41. In more recent years, national IPD surveillance showed further decline in PCV13 serotypes (except serotype 3) 5.…”

Section: Discussionmentioning

confidence: 99%

Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015

LeBlanc

ElSherif

et al. 2020

BMJ Open Resp Res

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BackgroundIn Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age.MethodsSurveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed prospectively from 2010 to 2015. CAP was radiologically confirmed, and pCAP was identified using blood and sputum culture and urine antigen testing. Patient demographics and outcomes were stratified by age (16–49, 50–64, ≥65 and ≥50 years).ResultsOf 6666/8802 CAP cases tested, 830 (12.5%) had pCAP, and 418 (6.3%) were attributed to a PCV13 serotype. Of PCV13 pCAP, 41% and 74% were in adults aged ≥65 and ≥50 years, respectively. Compared with non-pCAP controls, pCAP cases aged ≥50 years were more likely to be admitted to intensive care units (ICUs) and to require mechanical ventilation. Older adults with pCAP were less likely to be admitted to ICU or required mechanical ventilation, given their higher mortality and goals of care. Of pCAP deaths, 67% and 90% were in the ≥65 and ≥50 age cohorts, respectively.ConclusionsAdults hospitalised with pCAP in the age cohort of 50–64 years contribute significantly to the burden of illness, suggesting that an age-based recommendation for adults aged ≥50 years should be considered in order to optimise the impact of pneumococcal vaccination programmes in Canada.

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Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices

Cited by 290 publications

References 18 publications

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

Estimating the Clinical and Economic Impact of Switching from the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) to the 10-Valent Pneumococcal Conjugate Vaccine (PCV10) in Italy

Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015

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