Education, Research, and Quality Improvement: Education, Research, and Quality Improvement |

Use of PCV13 and PPSV23 in Adult Population: Are We Following the Advisory Committee on Immunization Practices Recommendations? FREE TO VIEW

Abdulmonam Ali; Amal Milad, MD; Mohammad Taleb, MD; Yousef Al Ahwel, MD; Rahman Shehnaz, MD; Dan Olson, MD
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University of Toledo, Toledo, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):604A. doi:10.1016/j.chest.2016.08.696
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SESSION TITLE: Education, Research, and Quality Improvement

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Monday, October 24, 2016 at 12:00 PM - 01:30 PM

PURPOSE: The Advisory Committee on Immunization Practices (ACIP) recommended routine use of pneumococcal conjugate vaccine (PCV13) for adults age 19 through 64 years with immunocompromised conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants and all adults aged 65 years or older. PCV13 should be administered to all eligible adults in addition to the pneumococcal polysaccharide vaccine (PPSV23)1. We think that the PCV13 is still underutilized by general practitioners as well as other medical sub-specialty physicians including pulmonologists. We conducted this study as quality improvement project to estimate the number of inpatients who could potentially benefit from the PCV13 vaccine.

METHODS: This was a single tertiary center admission data review, the sample of patients reviewed were over the period of time from October, 2012 till December, 2012.

RESULTS: The total admissions (excluding readmissions) were 2219 patients. There was only 190 candidates for PPSV23, of whom 163 patients received the PPSV23 vaccine and 27 candidate declined the vaccination. The rest of admissions either had already been vaccinated elsewhere or did not qualify. Of the 163 patients, there was 49% age group 19-64 years old, and 51% age of 65 years or older. All patients who had received the PPSV23 were qualified to one or more of the eligibility criteria as per ACIP recommendations. We applied the ACIP eligibility criteria for PCV13 on the patients who received the PPSV23 and we found 48 patients (29%) are actually also candiadates for PCV13 from the age group 19-64, in addition to 83 patients who were 65 years or older. The majority of those who were qualified from the age group 19-64 yrs old were under the following subcategories: generalized malignancy (29 patients), followed by five patients with immunodeficiency conditions, three patients with chronic renal failure (CRF), two patients with asplenia, two patients with solid organ transplant and the rest under other PCV13 indications.

CONCLUSIONS: According to ACIP new recommendations, there was 48 (29%) candidates for PCV13 in our study population who were vaccinated with PPSV23 from the age group 19-64 and 83 (51%) of those 65 yrs or older. This was a significant number of patients, none of them received the PCV13 vaccine. Therefore, clinicians should consider PCV13 for all patients who qualify as it can elicit opsonophagocytic activity and geometric mean antibody titers comparable or higher than responses elicited by PPSV23. We think more accurate data with regard to the potential candidates for PCV13 vaccine could be obtained by directly applying the ACIP eligibility criteria for outpatient settings including medicine clinics, dialysis units, infectious disease, Hematology-Oncology, and renal transplant clinics.

CLINICAL IMPLICATIONS: We think this Observational data review is very imprtant in two aspects: first the PCV13 is still underutilized despite the existance of many potential candidates and secondly, we are not sure about the awareness of the general practioners, pulmonolgists and other sub-spciality physicians about recognizing the potential candidates for PCV13.

DISCLOSURE: The following authors have nothing to disclose: Abdulmonam Ali, Amal Milad, Mohammad Taleb, Yousef Al Ahwel, Rahman Shehnaz, Dan Olson

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