A Closer Look at the Pulmonary PRN
OVERVIEW OF THE PRN
The Pulmonary Practice and Research Network (Pulm PRN) includes clinical pharmacists and in-training members who practice in both pulmonary and nonpulmonary settings. Its members have a vested interest in pulmonary disease management, education, and research. The mission of the Pulm PRN is to advance awareness of evidence-based medical management for acute and chronic pulmonary disorders.
OPPORTUNITIES AND RESOURCES
Chartered in 2019, the Pulm PRN has grown to include 93 active members, including 8 student and 2 resident members. The Pulm PRN enthusiastically welcomes all trainee members, whether they are Pharm.D. students, graduate students, residents, or fellows! Trainees are encouraged to participate on any of the PRN committees, including the Workforce and Strategic Planning; Education, Programming, and Communications; and Research committees. The Pulm PRN maintains a Twitter page, @ACCPpulmPRN, and tweets member accomplishments and evidence-based updates in pulmonary pharmacotherapy. Its student members help maintain and grow the PRN’s social media presence, and their efforts are appreciated. The Pulm PRN is committed to supporting its trainees’ engagement at the ACCP Annual Meeting and offers one student/resident travel award each year to help defray registration costs associated with trainee attendance.
CURRENT CLINICAL ISSUE: NEW PNEUMOCOCCAL VACCINES
Historically, two vaccinations were recommended for the prevention of pneumococcal disease: the 13-valent conjugate pneumococcal vaccine (PCV13, Prevnar 13) and the 23-valent polysaccharide pneumococcal vaccine (PPSV23, Pneumovax 23).
In late 2021, the FDA approved two new vaccines, both conjugate vaccines, for the prevention of pneumococcal disease: a 15-valent vaccine (PCV15, Vaxneuvance) and a 20-valent vaccine (PCV20, Prevnar 20). Compared with polysaccharide vaccines, conjugate vaccines elicit the immune response to produce memory B cells, which may lead to a stronger and more persistent immunity. Both PCV15 and PCV20 cover the same 13 serotypes as the existing conjugate vaccine, PCV13. PCV15 covers two additional serotypes, which may be responsible for 15% of invasive pneumococcal disease; and PCV20 adds an additional seven serotypes, which may be responsible for 30% of invasive pneumococcal disease. Adverse effects with the new PCV20 and PCV15 are expected to be similar to previous immunizations with PCV13. Patients may expect injection site pain, swelling, fatigue, and headache after the injection, with symptoms resolving after vaccination. No serious adverse reactions or deaths attributable to the vaccines were observed in their respective clinical trials.
The Advisory Committee on Immunization Practices provided guidance in early 2022 on the clinical use of the two new pneumococcal vaccines. Simplified recommendations are as follows:
New Pneumococcal Vaccine Recommendations (April 2022)
Adults 19–64 yr of age with chronic medical conditionsa
Adults ≥ 65
1 dose followed by PPSV23 1 yr later
Note: The minimum time between PCV15 and PPSV23 is 8 wk, and this shorter time may be considered if the patient is immunocompromised or has a cochlear implant or a CSF leak
1 dose of PCV20 only; PPSV23 boosting not yet recommended
aA full list of eligible conditions is available from the CDC at https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html.
Adults previously vaccinated with PPSV23 only (and not PCV13) are candidates to receive either PCV15 or PCV20 at least 1 year after their last PPSV23 immunization. Any adult patient who has previously received PCV13 is not yet recommended to receive PCV15 or PCV20. Instead, adults previously vaccinated with PCV13 should receive PPSV23 per the CDC’s Pneumococcal Vaccine Timing for Adults algorithm at https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf.
All that glitters is not gold, however. Less is known about whether PCV15 and PCV20 are better than previous vaccines at preventing pneumonia, bloodstream infections, or bacterial meningitis. PPSV23 has the broadest coverage of all the pneumococcal vaccines, and at least 8% of invasive disease is caused by the serotypes contained in PPSV23; hence, patients who receive one of the new pneumococcal vaccines will still require one dose of PPSV23 1 year later. Feel comfortable recommending either PCV15 or PCV20 depending on which vaccine is not only available at your community, ambulatory, or hospital pharmacy but also covered by your patient’s pharmacy benefits.
It’s challenging to stay up-to-date with pneumococcal vaccine recommendations. Check out the CDC’s PneumoRecs VaxAdvisor mobile app at https://www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html.
Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the Advisory Committee on Immunization Practices – United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109-17.
Paul M. Boylan, Pharm.D., BCPS
Assistant Professor, The University of Oklahoma College of Pharmacy
Paul Solinsky, Pharm.D., BCACP
Clinical Pharmacist, Baltimore Washington Medical Center
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