The recommendation regarding a pneumonia vaccine by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has some doctors wondering exactly what they should be telling their patients over the age of 65.
Dr. Claudia Gruss, president of the Connecticut State Medical Society, said she would like to listen to the discussion held last week in Atlanta before reaching any conclusions about the recommendation, which still needs to be published in the Morbidity and Mortality Weekly Report before it is considered final.
In a close vote, Advisory Committee on Immunization Practices (ACIP) members decided not to recommend Prevnar 13 or PCV 13 for all adults age 65 or older who have not previously received it. The decision revises a 2014 recommendation that all individuals over the age of 65 receive the vaccine.
The committee voted 8-6 not to recommend it for all adults based on the indirect effects from pediatric PCV 13 use.
The committee recommended instead that the decision to give the vaccine to older adults be left to doctors and patients. The recommendation seems to suggest that patients with compromised or suppressed immune systems should talk to their physician about receiving the vaccine. However, no details have yet been made available regarding any newly discovered risks from the vaccine in people with compromised immune systems. The video of the advisory committee’s June 26 meeting has not yet been made available publically.
Gruss said she would like to see more data so she can make an informed decision about which immuno-compromised patients would benefit from receiving the vaccine.
“We need more information about why this decision was made so then we can interpret this information for our patients,” Gruss said. “Hopefully they come out with a more definitive decision and tell us why they changed recommendation.”
There has been some discussion that pneumonia vaccines given to children have contributed to a reduction in cases among older adults.
Each year, about 18,000 Americans die from pneumococcal disease and its complications, costing the healthcare system $1.86 billion.
“I really think we need a lot more research and thought in the whole area of shared decision making and identifying high-risk groups,” said ACIP voting member Peter Szilagyi, MD, MPH, executive vice-chair of the department of pediatrics at the University of California, Los Angeles, during the June 26 the meeting. “Obviously, the over-65-year-old, non-immunocompromised [population] is not a homogenous group.”
The National Association of Nutrition and Aging Services Programs (NANASP) worries about what this recommendation will mean in practice —that it could lead to confusion among patients, with many seniors not being able to access a vaccine.
Bob Blancato, executive director of the NANASP, said there could be consequences. Blancato advocated to keep the current practice of administering the vaccine to all adults over the age of 65, and said he worries the decision will cause the Centers for Medicare and Medicaid Services to stop or limit Medicare coverage of the vaccine.
Blancato said he’s pleased the ACIP voted down a proposal to “completely eliminate a key pneumococcal disease vaccination for older Americans. However, we have concerns that the shared clinical decision-making recommendation that was approved will lead to confusion among healthcare providers and most importantly, patients.”
Pfizer, the drug company that manufactures Prevnar 13, said the recommendation reinforces that Prevnar 13 is considered safe and effective.
“Direct vaccination remains the best available tool to help prevent against pneumococcal disease and the revised recommendation emphasizes the importance of the health care professional and patient relationship in shared decision making regarding vaccination,” said Luis Jodar, Pfizer Vaccines, Chief Medical and Scientific Affairs Officer, in a press release.