{"id":845,"date":"2015-10-08T14:57:15","date_gmt":"2015-10-08T14:57:15","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=845"},"modified":"2017-08-21T11:33:58","modified_gmt":"2017-08-21T11:33:58","slug":"primary-care-corner-with-geoffrey-modest-md-immunization-updates","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/10\/08\/primary-care-corner-with-geoffrey-modest-md-immunization-updates\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Immunization Updates"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>So, on rare occasions, there is news which makes life easier for primary care (sort of like the convergence of a lunar eclipse and a super moon).<\/p>\n<p><a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2015\/10\/full-moon-914410_640.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-846 aligncenter\" src=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2015\/10\/full-moon-914410_640.jpg\" alt=\"full-moon-914410_640\" width=\"640\" height=\"280\" \/><\/a><\/p>\n<ol>\n<li>The CDC&#8217;s Advisory Committee on Immunization Practices (ACIP)\u00a0has actually\u00a0simplified the pneumococcal vaccine schedule (see\u00a0<a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6434a4.htm?s_cid=mm6434a4_w\">http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6434a4.htm?s_cid=mm6434a4_w<\/a> ). I have sent out prior blogs detailing the confusing administration of PCV-13 (the 13-valent vaccine which has been given to kids for years) and PPSV-23 (the old 23-valent vaccine for adults)\u00a0in immunocompetent adults\u00a0&gt;65yo, highlighting that the dose of PCV-13 should be at least one year after PPSV-23;\u00a0though if PCV-13 is given first, then the PPSV-23 could be given 6-12 months later. So, the new recommendation is to wait &gt;= 1 year in either of the\u00a0 PPSV-23\/PCV-13 sequences\u00a0(note: there are no clinical data on the timing of the different vaccines, just immunogenicity studies which really do not even address these intervals directly,\u00a0and one study\u00a0finding more localized injection-site\u00a0swelling if given at 2 month intervals vs 6 months apart). So, now, the common scenarios for an immunocompetent adult &gt;65yo are:<\/li>\n<\/ol>\n<ul>\n<li>If never got vaccine, give PCV-13 at age 65, then wait a year and give PPSV-23<\/li>\n<li>If already\u00a0given PPSV-23, then wait a year and give PCV-13 (no earlier than 65yo)<\/li>\n<li>But, if got PPSV-23 younger than age 65 (smoker, asthma, chronic lung disease, etc. etc.), then give PCV-13 at age 65 (if at least one year after the PPSV-23), and\u00a0then can get their regular post-65 PPSV-23\u00a0if at least 1 year after the PCV-13 <strong>and<\/strong> 5 years after their last PPSV-23.<\/li>\n<li>If a dose of PPSV-23 is inadvertently given earlier than recommended, don&#8217;t repeat the dose.<\/li>\n<li>Remember that\u00a040% of invasive pneumococcal infections occurring in those &gt;65yo are caused by serotypes unique to PPSV-23\u200b\u200b: i.e., we should generally make sure that those &gt;65 yo get both vaccines<\/li>\n<\/ul>\n<p>Got it? (It actually is a slight bit simpler&#8230;.)<\/p>\n<p>But,\u00a0for immunocompromised people (asplenia, HIV, nephrotic syndrome, chronic renal failure,\u00a0congenital immunodeficiency, cancers, organ transplant), the interval for all patients\u00a0above age 2 is PCV-13 followed by PPSV-23 after 8 weeks. If they got PPSV-23 first, they should wait 8 weeks for PCV-13 until they are 18yo, thereafter wait 1 year.<\/p>\n<ol start=\"2\">\n<li>So far, not a lot of influenza activity in the US (through 9\/5\/15), but the good news: all of the virus samples collected so far in the US and other countries have been &#8220;antigenically and\/or genetically characterized as being similar to the influenza vaccine viruses recommended for inclusion in the 2015-2016 Northern Hemisphere vaccine\u201d (see <a href=\"http:\/\/1.usa.gov\/1VGKSHe\">http:\/\/1.usa.gov\/1VGKSHe<\/a>). I.e., it seems like a good match. Which is, by the way, really different from last year, where there was really low vaccine effectiveness against the predominant influenza A (H3N2) virus, and the laboratory data showed a poor antigenic\/genetic match. \u00a0We&#8217;ll see&#8230;.. \u00a0But at least it looks good so far.<\/li>\n<\/ol>\n<p>By the way, the breakdown for the first 1698 cases of influenza so far in the US is 54% influenza A (of which 5% were pH1N1, 93% H3N2), 46% influenza B. There have been a handful of variant viruses but of the H3N2 and H1N1 strains. All of the tested viruses were susceptible to neuraminidase inhibitors, but adamantanes (e.g. amanadine) does not work\/lots of resistance.\u200b<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Dr. Geoffrey Modest So, on rare occasions, there is news which makes life easier for primary care (sort of like the convergence of a lunar eclipse and a super moon). The CDC&#8217;s Advisory Committee on Immunization Practices (ACIP)\u00a0has actually\u00a0simplified the pneumococcal vaccine schedule (see\u00a0http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6434a4.htm?s_cid=mm6434a4_w ). I have sent out prior blogs detailing the confusing [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/10\/08\/primary-care-corner-with-geoffrey-modest-md-immunization-updates\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-845","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/845","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=845"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/845\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=845"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=845"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=845"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}