The addition of Prevnar 13 to the pneumococcal vaccination protocol has certainly made the algorithm a bit more complicated. This is the updated workflow.
Since the introduction of 7-valent pneumoccal vaccine (PCV 7) in the US immunization schedule there has been a steady decline in the number of invasive pneumococcal disease as reported in the July 11th issue of the New England Journal of Medicine by Griffen et al.
The annual rate of hospitalization for pneumonia among children younger than 2 years of age declined by 551.1 per 100,000 children (95% confidence interval [CI], 445.1 to 657.1), which translates to 47,000 fewer hospitalizations annually than expected on the basis of the rates before PCV7 was introduced. The rate for adults 85 years of age or older declined by 1300.8 per 100,000 (95% CI, 984.0 to 1617.6), which translates to 73,000 fewer hospitalizations annually. For the three age groups of 18 to 39 years, 65 to 74 years, and 75 to 84 years, the annual rate of hospitalization for pneumonia declined by 8.4 per 100,000 (95% CI, 0.6 to 16.2), 85.3 per 100,000 (95% CI, 7.0 to 163.6), and 359.8 per 100,000 (95% CI, 199.6 to 520.0), respectively. Overall, we estimated an age-adjusted annual reduction of 54.8 per 100,000 (95% CI, 41.0 to 68.5), or 168,000 fewer hospitalizations for pneumonia annually. 
This is the screen cast of a lecture titled “Outbreaks in extended care facilities (ECF)” given by Irfan Hafiz MD on April 19th 2013 at Centegra McHenry Hospital. It was co-sponsored by Centegra Health System and the McHenry County Dept. of Health.
Topics included in the lecture include:
- Identifying current and emerging infectious disease common to long term care facilities (LTCF).
- Describe preventive interventions for infectious disease in the context of LTCF.
- Describe the unique challenges facing LTCF in the context of infectious diseases.
For upcoming lectures please look at the calendar and filter by “Education Events”.
Myths of immunization
This lecture was presented at the recent fall nursing symposium.
References and links
- Inflammation described by Celsus
- What is an antigen?
- Types of immunity
- Plague in the middle ages
- How India has defeated Polio, a BBC report
- Edward Jenner – the man who saved more lives than any other man
- Herd immunity
- Algorithm for immunizing persons with egg allergies
- Influenza vaccination in individuals with egg allergies
- Ileal-lymphoid nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children, Lancet 1998- the original article by AJ Wakefield that started the controversy over vaccination in the late 1990s
- Wikipedia article on Andrew Wakefield
- My comments on Wakefield findings dated January 2011
- Article in The Telegraph reporting on the outbreak of Measles in Liverpool
- Risk of seizures after whole cell pertussis or Measles, Mumps, and Rubella vaccine
- Gates foundation and vaccination
Invasive pneumococcal disease is the most common vaccine preventable disease worldwide
A few key point on Pneumovax (23-valent):
- There is no contraindication to give pneumovax at hospital admission.
- Invasive pneumococcal disease is the most common vaccine preventable disease worldwide. 40,000 deaths are attributable to invasive pneumococcal disease in the US annually.
- Current 23-valent polysaccharide vaccine covers 95% of the most common causes of invasive pneumococcal disease.
- Vaccination reduces rates of death from invasive pneumococcal disease. At least half of these deaths are preventable with vaccination.
- Pneumovax reduces duration of hospitalization for CAP. 1
- Pneumovax reduces rates of death from myocardial infarction and strokes as shown in a recent prospective trial 2
- The goal of pneumovax is to reduce death from invasive pneumococcal disease NOT to reduce the number of pneumonia cases.
- The current national average for patients 65 years of age and over is 65% coverage. This is too low.
- To address the issue of why only one dose after the age of 65 please see the attached algorithm that I put together. I hope that it better explains who needs to be vaccinated and how often. The recommendations are that EVERYONE get one dose of pneumovax after the age of 65. Anyone with additional risk factors will get the greater interval of vaccination per the higher risk group.
This algorithm has been updated to include the new Prevnar guidelines on 12/25/13
- Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587. http://www.ncbi.nlm.nih.gov/pubmed/20887208.
- Dominguez, Angela, Lluis Salleras, David S Fedson, Conchita Izquierdo, Laura Ruiz, Pilar Ciruela, Asuncion Fenoll, and Julio Casal. 2005. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 40, no. 9 (May): 1250-7. doi:10.1086/429236. http://www.ncbi.nlm.nih.gov/pubmed/15825026.
- Vila-Córcoles, Angel, Olga Ochoa-Gondar, Imma Hospital, Xabier Ansa, Angels Vilanova, Teresa Rodríguez, and Carl Llor. 2006. Protective effects of the 23-valent pneumococcal polysaccharide vaccine in the elderly population: the EVAN-65 study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 43, no. 7 (October): 860-8. doi:10.1086/507340. http://www.ncbi.nlm.nih.gov/pubmed/16941367.
- Johnstone, Jennie, Thomas J Marrie, Dean T Eurich, and Sumit R Majumdar. 2007. Effect of pneumococcal vaccination in hospitalized… [Arch Intern Med. 2007] – PubMed result. Archives of internal medicine 167, no. 18 (October): 1938-43. doi:10.1001/archinte.167.18.1938. http://www.ncbi.nlm.nih.gov/pubmed/17923592.
- Jackson, Lisa a, and Edward N Janoff. 2008. Pneumococcal vaccination of elderly adults: new paradigms for protection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 47, no. 10 (November): 1328-38. doi:10.1086/592691. http://www.ncbi.nlm.nih.gov/pubmed/18844484.
- Fisman, David N, Elias Abrutyn, Kimberly A Spaude, Alex Kim, Cheryl Kirchner, and Jennifer Daley. 2006. Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 42, no. 8 (April): 1093-101 doi:10.1086/501354 ↩
- Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587 ↩