Letter to Long-term Care Facilities Regarding Pneumococcal Vaccine for Adults

March 25, 2016
DAL NH 16-01

Dear Nursing Home Administrator:

New York State (NYS) Public Health Law Article 21-A requires facilities to offer influenza and pneumococcal vaccination to all residents and employees who are eligible to receive it. For compliance with this statutory requirement, the Department recommends LTCFs follow the most current recommendations of the Advisory Committee on Immunization Practices (ACIP) for vaccination against pneumococcal disease. ACIP recommendations constitute the medical standard of care for vaccination in the United States, are endorsed by the Centers for Disease Control and Prevention and are consistent with recommendations of the American College of Physicians and the American Academy of Family Physicians.

The new standard of care for pneumococcal vaccination of adults is that both pneumococcal conjugate vaccine (PCV13, Prevnar-13®) and pneumococcal polysaccharide vaccine (PPSV23, Pneumovax®23) be routinely administered to all adults aged 65 years and older. Additionally, ACIP also recommends pneumococcal vaccination of certain high-risk adults aged 19-64 years.

  • Adults aged 65 years or older should first be vaccinated with PCV13 and then be vaccinated with PPSV23 at least 1 year later.
  • Adults 65 years of age or older who had previously received PPSV23, should receive a dose of PCV13 at least 1 year after the first dose.
  • Adults aged 19-64 years with the following chronic medical conditions should receive one dose of PPSV23:
    • heart disease (excluding hypertension)
    • lung disease (including asthma)
    • liver disease (including cirrhosis)
    • diabetes
    • alcoholism
  • Adults aged 19-64 years with the following "higher risk" chronic conditions should receive one dose of PCV13 followed by one dose of PPSV23 at least 8 weeks later:
    • cerebrospinal fluid leaks
    • those who are candidates for or are recipients of a cochlear implant
  • Adults aged 19-64 years with the following "highest risk" chronic conditions should receive one dose PCV13 followed by a first dose of PPSV23, at least 8 weeks later, AND a second dose of PPSV23 five years after the first dose:
    • immunocompromised conditions (e.g., HIV infection)
    • chronic renal failure or nephrotic syndrome
    • functional or anatomic asplenia (e.g., sickle cell disease, splenectomy).
  • For adults 19-64 years of age, the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.
  • Adults 19-64 years of age or older, who are recommended to receive PCV13 and have previously received PPSV23, may receive PCV13 if at least 1 year has passed since their dose of PPSV23.
  • The two vaccines must not be co-administered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.
  • Effective February 2, 2015, and retroactive to September 19, 2014, Medicare Part B will cover both pneumococcal vaccines provided a minimum of 11 months have passed between the first and second doses.

The Department recommends LTCFs take the following steps immediately:

  • Revise their current immunization policies and/or adopt the attached non-patient specific standing orders to ensure that all residents are screened and offered the appropriate pneumococcal vaccine. For long-stay residents, facilities should reassess the need for subsequent doses of pneumococcal vaccine as indicated by the ACIP recommendations. Upon discharge, residents will be advised to schedule appointments with their primary care providers for the second dose of pneumococcal vaccine, if indicated.
  • Ensure that all employees are educated about the pneumococcal vaccines and the ages and medical conditions for which vaccination is recommended, at their annual employee health assessment. LTCFs should offer the appropriate pneumococcal vaccine to employees when indicated.
  • Implement policies and procedures to ensure that immunization histories of all residents are routinely reviewed in the New York State Immunization Information System (NYSIIS), outside of New York City (NYC), or the Citywide Immunization Registry (CIR) within NYC, the electronic health record (EHR), and/or the regional health information organization (RHIO), where available.
    • LTCFs should work with their EMR and/or RHIO to implement data exchange with NYSIIS and/or the CIR in order to facilitate immunization history review and reporting.
    • The Department also urges all providers to obtain consent for NYSIIS or the CIR reporting from all adult patients and report all doses of vaccine to NYSIIS or the CIR.

Furthermore, vaccination should not be delayed due to a lack of a written immunization record. If immunization records are not available, it is acceptable to rely on the patient's verbal immunization history to determine whether and which pneumococcal vaccine is indicated.

Decision-making algorithms and sample non-patient specific standing orders for administering pneumococcal vaccine to adults are attached to this letter to assist with understanding the schedule. Any questions regarding ACIP recommendations, NYSIIS or best practices for immunization may be directed to the New York State Department of Health Bureau of Immunization at (518) 473-4437. Any questions regarding compliance with Article 21-A may be directed to the New York State Department of Health Division of Nursing Homes, Bureau of Quality Assurance at 518-408-1267.


Sincerely,

Shelly Glock, Director
Division of Nursing Homes and ICF/IID Surveillance Center for Health Care Provider & Oversight
Elizabeth Rausch-Phung, M.D., M.P.H.
Director, Bureau of Immunization
Office of Public Health

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