At an August 13 meeting at the Centers for Disease Control & Prevention (CDC) headquarters in Atlanta, Tamara Pilishvili, MPH, Respiratory Diseases Branch, CDC National Center for Immunization & Respiratory Diseases, summarized the evidence, cost-effectiveness, and GRADE conclusions following CAPITA (Community-Acquired Pneumonia Immunization Trial), which included 85,000 individuals.
As a result of this trial, the Advisory Committee on Immunization Practices (ACIP) issued the following recommendations:
- Adults 65 years of age or older who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of 13-valent pneumococcal conjugate vaccine (PCV13) first, followed by a dose of pneumococcal polysaccharide vaccine (PPSV23).
- Adults 65 years of age or older who have not previously received PCV13 and who have previously received one or more doses of PPSV23 should receive a dose of PCV13.
- The recommendations for routine PCV13 use among adults over 65 years old should be re-evaluated in 2018 and revised as needed.
At the meeting, participants whether both vaccines would be covered by Medicare.
CMS has a mechanism for modifying the coverage policy based on the ACIP’s recommendation, but that if the recommendation went into effect in the fall of 2014, coverage may not be effective until January 2016, noted Joseph Chin, MD, MS, Coverage and Analysis Group, CMS, in an article.
Further clarification of Medicare policy indicated that the first dose of the conjugate vaccine would be immediately covered for unvaccinated adults. This may apply to as many as 15 million Medicare beneficiaries over the age of 65 years have not received the pneumococcal vaccine.
ACIP will review its recommendation in 2018 and revise, if necessary. The report is available on the CDC’s Morbidity and Mortality Weekly Report.