icekitsune

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Sep 9, 2008
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I need some opinion on this situation. Patient who is 66 yo comes in wanting a pneumonia shot along with flu shot. Pharmacy carries prevnar 13. It says patient can get prevnar if they never had a pneumonia shot but I also found out elsewhere that its recommended for patients who never had a pneumonia shot to get the pneumovax 23 for patient over 65. I know pneumovax 23 covers more serotypes, would you give the prevnar since its the only available at that moment?
 

BidingMyTime

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The Prevar 13 should only be given to an adult if there are are specific health conditions that warrant it (IE HIV+) You should tell your 66+ pt that you only currently have the pediatric form, and that you will order the adult form for her/him, and call her/him when it comes in. At least this is the current recommendation & standard of practice (the info sherlockRX links to says that this recommendation is changing, but I'm not aware that is has actually been changed yet.)
 

OmiPharmD

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I believe SherlockRX was perhaps referring to this - it was in the late August APhA Immunizing Pharmacists News email. This is directly copied and pasted from the email.

ACIP Votes to Recommend Dose of Pneumococcal Conjugate Vaccine (PCV13) in Addition to Pneumococcal Polysaccharide Vaccine (PPSV23) for All Adults Age 65 and Older

At its special meeting on August 13, ACIP voted to recommend a dose of PCV13 for all adults age 65 years and older; recommendations for the use of PPSV23 in adults age 65 years and older were updated as well. The main points of the new vaccine recommendations that were presented and voted upon at the August 13 ACIP meeting appear below:
  • Adults age 65 years of age and older who have not previously received pneumococcal vaccine or whose previous pneumococcal vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The PPSV23 dose should be given 6 to 12 months following the PCV13 dose. If a dose of PPSV23 cannot be given in this time window, give it at the next visit. Do not administer the PCV13 and PPSV23 at the same visit.
  • Adults age 65 and older who have not received PCV13 and who have previously received one or more doses of PPSV23 should receive a dose of PCV13. The PCV13 dose should be given one year after receipt of the most recent dose of PPSV23. For those for whom an additional dose of PPSV23 is indicated, this dose should be given 6 to 12 months after PCV13 and at least 5 years after the most recent dose of PPSV23.
Once they are reviewed and approved by the CDC’s Director and the U.S. Department of Health and Human Services, ACIP recommendations are published in the Morbidity and Mortality Weekly Report (MMWR). The MMWR publication represents the final and official CDC recommendations for immunization of the U.S. population.

Related Links
Source: Immunization Action Coalition. IAC Express. Issue No. 1138. August 19, 2014.
 

BidingMyTime

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Once they are [b/reviewed and approved[/b] by the CDC’s Director and the U.S. Department of Health and Human Services.
And this is what I was referring to, while it does sound like most likely the standard of practice will be changing, it hasn't changed yet, which means the old standard of practice is, well still the current standard of practice.
 

KARM12

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We generally don't update our recommendations until it is approved by the CDC and incorporated into the immunization schedule. This will likely happen eary 2015.
 
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Old Timer

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We generally don't update our recommendations until it is approved by the CDC and incorporated into the immunization schedule. This will likely happen eary 2015.
They are updated as of October 2014......
 
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KARM12

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They are earlier than normal. Well there are the new recs.
 

waiter

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Apr 20, 2013
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I'm getting Medicare Part B rejections trying to give Prevnar, "max 1 dose / lifetime." It seems their Pneumovax is disqualifying them from Prevnar in the eyes of CMS.