Uncertainty on pneumococcal guidelines calls for pharmacy vaccination support

Adult pneumococcal immunization recommendations have changed several times over last 10 years

Results of a nationwide survey on pneumococcal vaccination exposed gaps in primary care physician (PCP) knowledge of the 2015 Advisory Committee on Immunization Practices (ACIP) adult pneumococcal vaccine recommendations.

The study also showed that nearly all PCPs readily stock and recommend the pneumococcal 13-valent conjugate vaccine ([PCV13] Prevnar 13—Merck) and the pneumococcal polysaccharide vaccine ([PPSV23] Pneumovax 23—Merck). The authors suggested, however, that improved vaccine management will require making physicians aware of insurance coverage and addressing knowledge gaps about evidence-based recommendations.

“The adult pneumococcal immunization recommendations have changed several times over the last 10 years, as more data has become available in different high-risk populations, and this has caused confusion among health care professionals,” explained Bernadette Jakeman, PharmD, PhC, BCPS, AAHIVP, associate professor at the University of New Mexico College of Pharmacy. “I find that health care professionals typically know the target populations for pneumococcal vaccination in adults but are unsure about the appropriate formulation or timing of the dosing intervals.”

Recognizing barriers

Streptococcus pneumoniae bacteria causes approximately 445,000 hospitalizations annually in the United States, which places a significant burden on health care utilization and costs. In 2015, roughly 29,500 cases of invasive pneumococcal disease resulted in 3,350 deaths.

Despite these outcomes and the availability of longstanding ACIP recommendations for PPSV23, vaccination coverage is just 23% for those aged 19 to 64 years old at high risk for pneumococcal disease. Often enough, patients miss chances for receiving pneumococcal vaccines by missing regular check-ups or disregarding PCP vaccine recommendations.

“Certain patients will see their providers only when they are sick, and they are not perhaps as focused on preventative work. It would be during those healthy checkups and healthy visits that the provider would be more procedural in offering adult vaccinations,” said Kerry LaPlante, PharmD, FCCP, FIDSA, professor of pharmacy at the University of Rhode Island, adjunct professor of medicine at Brown University, and vice-chair for the Rhode Island Department of Health’s Antimicrobial Stewardship and Environmental Cleaning Task Force. “I think providers want to do a good job, just like patients want to be treated well.”

For those who slip through cracks in the PCPs’ preventive medicine floorboards, however, opportunity for pneumococcal vaccination may be found elsewhere. Pharmacists, in particular, are well equipped to provide patients with access to vaccines.

Pharmacy-driven vaccination

Community pharmacies are uniquely positioned to provide a number of public health services, including immunizations. Jakeman described reports showing that most patients live within 5 miles of a pharmacy and frequent them more often than their PCPs’ offices. This creates a great margin of opportunity for pharmacists to affect health outcomes of entire communities.

“We are the most accessible health care profession. Being able to vaccinate was a huge step forward for pharmacists,” said LaPlante. “I feel strongly about that just because of the access we have. We are a process-oriented type of profession, and I think we are well set up to provide vaccinations and maintain those vaccination records, too.”

Many patients decline receipt of vaccines simply because they cannot remember which shots they have already received or whether they were vaccinated in the first place. As LaPlante pointed out, this exposes an area where pharmacy can lead process improvement through comprehensive documentation and use of electronic medical records.

Through regular screening, vigilant inpatient pharmacists may also contribute to improved vaccination rates. Patients, both inpatient and outpatient, often have one or more indications for pneumococcal vaccination.

“Pharmacists need to make sure that they are aware of the most recent ACIP recommendations,” encouraged Jakeman. “Each year a new vaccination schedule comes out. In addition, updates are available on the CDC website after the schedule is published. Sometimes the changes from year to year may only be reflected in the schedule’s footnotes, such as changes in dosing intervals or at-risk groups.”


For more information, see the full article in the upcoming April 2018 issue of Pharmacy Today on www.pharmacytoday.org.