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Pneumococcal disease: Give your most vulnerable patients a shot

Pneumococcal infections can cause serious diseases including bacteraemia, meningitis and pneumonia. Prevenar 13® (Pneumococcal polysaccharide conjugate vaccine, 13-valent adsorbed) is used regularly in infants as part of the Australian National Immunisation Program (NIP),1 but it may not be common knowledge that Prevenar 13 is also indicated for use in adults.2

Adults become more susceptible to infections like pneumococcal disease when they have conditions which compromise their immune system.3 The Australian Immunisation Handbook (AIH) is the most informed resource for identifying at-risk patients and understanding which vaccines are recommended.1

The AIH defines conditions associated with the highest risk of invasive pneumococcal disease (IPD) as Category A conditions:1

  • Asplenia e.g. splenectomy
  • HIV/AIDS
  • Functional asplenia e.g. sickle cell disease
  • Solid organ transplant
  • Haematopoietic stem cell transplant
  • Congenital or acquired immune deficiency
  • Chronic renal failure or relapsing/persistent nephrotic syndrome
  • Immunosuppressive therapy (including corticosteroid therapy ≥2 mg/kg per day of prednisolone or equivalent for > 1 week) or radiation therapy, where sufficient immune reconstitution for vaccine response is expected
  • Intracranial shunts
  • Cerebrospinal fluid (CSF) leak
  • Haematological and other malignancies
  • Cochlear implants

High risk patients are on your records, but are they on your radar?

Pneumococcal vaccines, including Prevenar 13, are recommended for these patients. Prevenar 13 is recommended upon diagnosis,1 but it may not be this straightforward in daily practice. Your patients may have been diagnosed with their condition some time ago, received another pneumococcal vaccine previously, be unaware of their vaccination status, or even missed out on vaccination altogether.

Nurses make a difference by championing vaccination

Successful nurse-led vaccination initiatives include:

  • Screening and identification programs4,5
  • Telephone reminders +/- face-to-face reminders6
  • Electronic health record reminders7
  • Pre-visit care planning for preventative health7
  • Standing orders8,9

Growing evidence shows a combination of interventions integrating vaccination checks into routine clinical care increases vaccination uptake.6,9,10

A combination of strategies can help protect your most vulnerable patients against pneumococcal disease

You can:

  • Use your patient management system to screen and identify your patients with Category A conditions.
  • Use the PneumoSmart Vaccination Tool to help navigate the pneumococcal vaccine recommendation pathway. Input patient information via http://www.pneumosmart.org.au/clinicians/vaccination-tool/ to determine what pneumococcal vaccine they need, and when.
  • Integrate this into your recall/reminder systems to ensure pneumococcal vaccination status is discussed at their next appointment.
  • Document vaccines administered in the Australian Immunisation Register (AIR). For patients with compromised immune systems and multiple touchpoints within the health system it’s critical their records are up-to-date.

Nurses are in an ideal position to help protect vulnerable adult patients against pneumococcal disease. Using a multicomponent, collaborative approach in advocating pneumococcal vaccination is helpful – by establishing systems in your practice to prevent patients falling through the cracks, updating all practice staff on vaccine recommendations, administering the vaccines, documenting in the AIR and in providing patient education.

This article is supported by Pfizer.

Limited safety and immunogenicity data on PREVENAR 13 are available for patients with sickle cell disease, allogeneic haematopoietic stem cell transplant, or HIV infection, and are not available for other immunocompromised patient groups. Efficacy/effectiveness has not been established. Vaccination should be considered on an individual basis. Immunocompromised individuals or individuals with impaired immune responsiveness due to the use of immunosuppressive therapy may have a reduced antibody response to PREVENAR 13. Immunisation schedules for PREVENAR 13 should be based on official recommendations.

PBS

Please review full Product Information before prescribing. Product or any further information is available on request on 1800 675 229 or at www.pfizer.com.au

Minimum Product Information. Prevenar 13® suspension for IM injection. Indications: Active immunisation for the prevention of disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F in adults and children from 6 weeks of age. Dose: 0.5 mL I.M. Infants 6 weeks to 6 months of age: 3 doses at least one month apart. A single booster should be given in the second year, at least 2 months after the primary series. Previously unvaccinated children: Varies with age at first dose, see full PI. Children previously vaccinated with Prevenar (7vPCV): Children 12 months to 5 years who have completed primary infant immunisation with 7vPCV and children 6 to 17 years who have received one or more doses of 7vPCV may receive 1 dose, at least 8 weeks after the final dose of 7vPCV. Adults: 1 dose. Special Populations (higher risk, e.g. HIV, SCD): 1 dose. HSCT: 4 doses. If sequential administration of Prevenar 13 and 23vPPV is considered, give Prevenar 13 first. Contraindications: Hypersensitivity to any component of the vaccine, including diphtheria toxoid. Allergic or anaphylactic reaction following prior administration of 7vPCV. Precautions: Do not administer intravenously, intravascularly, intradermally or subcutaneously. Avoid injecting into or near nerves or blood vessels. Do not inject into gluteal area. Postpone administration in acute, moderate or severe febrile illness. Only protects against Streptococcus pneumoniae serotypes included in the vaccine and may not protect all individuals from pneumococcal disease. Consider the risks of I.M injection in infants or children with thrombocytopenia or any coagulation disorder. Appropriate treatment and supervision must be readily available in case of a rare anaphylactic event. Prophylactic antipyretic medication is recommended for children receiving concomitant whole-cell pertussis vaccines, and for children with seizure disorders or history of febrile seizures. Consider the potential risk of apnoea when administering to very premature infants. Very Common/Common Adverse Effects: Children 6 weeks to 5 years: Injection site reactions (redness, pain, swelling), fever, diarrhoea, vomiting, decreased appetite, drowsiness/increased sleep; restless sleep/decreased sleep, rash, irritability. Children and adolescents 5 to 17 years: Irritability, Injection site reactions (redness, pain, swelling), somnolence, poor quality sleep, injection site tenderness (including impaired movement), fever, decreased appetite, vomiting, diarrhoea, headaches, rash. Adults: Diarrhoea, vomiting, nausea, chills, fatigue, injection site reactions (redness, pain, swelling), limitation of arm movement, fever, new or aggravated joint or muscle pain, decreased appetite, headaches, rash. Adults >65 years reported fewer adverse effects than younger adults. Adverse effects were generally most common in young adults 18 to 29 years. See full PI for details (V10516).

References:

1. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook 10th Ed (2017 Update). Canberra: Australian Government Department of Health, 2017. Available at www.immunise.health.gov.au. Accessed September 2017.
2. PREVENAR 13® Approved Product Information.
3. National Centre for Immunisation Research and Surveillance, Adult Vaccination factsheet. Available at http://www.ncirs.edu.au/assets/provider_resources/factsheets/adult-vaccination-fact-sheeet.pdf. Accessed September 2017.
4. Serre J, et al. Eur J Intern Med. 2017; pii: S09536205(17)302200.
5. Byrnes P, et al. Aust Fam Physician. 2006; 35(7):5512.
6. Chan SS, et al. Int J Nurs Stud. 2015; 52(1):317-24.
7. Wright WL, et al. J Am Assoc Nurse Pract. 2017; 29(7):384-391.
8. Rhew DC, et al. J Gen Intern Med 1999;14:351–356.
9. Rittle C and Francis R, American Nurse Today 2016; 11(9):42-43.
10. Koch JA, J Gerontol Nurs. 2012; 38(2):31-9.

®Registered trademark. Pfizer Australia Pty Limited, 38–42 Wharf Road, West Ryde, NSW 2114. PP-PNA-AUS-0108. PFAPRE2412. 10/17. GHG.

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