Pneumococcal Vaccine Pathway

Patient Assessment

START PATIENT ASSESSMENT

General Information

Pneumococcal vaccination in adults is relatively complicated as it considers a variety of patient factors:

immune status
chances of acquiring a S. pneumoniae infection
co-morbidities that make getting an infection more risky
age
previous pneumococcal vaccinations and,
when they were given

Timing of Administration

Most patients can receive the vaccine safely while in hospital

Recovering from infections such as pneumonia has little negative impact on lymphocyte ability to produce antibodies

In fact, patients are more likely to accept a vaccine while they are in hospital due to increased health awareness

Administer the appropriate vaccine towards the end of the hospital stay

When to delay the Pneumococcal vaccine

Wait until the patient is out of the ICU/CCU/CVU
Splenectomized patients should wait 14 days post-op
If embarking on potent immunesupression (e.g. chemotherapy or immunologic treatment), attempt to vaccinate before hand

When not to delay

Patient receiving new immunosupressing drugs (e.g. prednisone) or antibiotics
Low lymphocytes or hypo-gammaglobulinemia
Patient doesn't feel well
Fever, increased WBC or signs of infection
Newly diagnosed HIV or any other immunocompromising chronic disease (e.g. CKD)

Vaccines Available

There are two products currently available for use in adults. They vary in their immunogenicity, the strains of pneumococcus they cover, how they can be given and their efficacy in different patient populations.

Evidence

This pathway was developed combining best practice guidelines, unique factors pertaining to Island Health and vaccine funding in BC

References:
Advisory Committee on Immunization Practices, 2015
Center for Disease Control
BC Provincial Immunization Guide

Coverage

This pathway is specific to inpatients at Island Health hospitals where both Prevnar 13 and Penumovax 23 are available free of charge.

While this pathway is equally valid for outpatients, outpatient vaccines may not be covered despite being recommended. In these scenarios, a recommendation will provide guidance on eligibility,

pricing and where to obtain these products.