DAL 16-01: Pneumococcal Vaccines Update

January 21, 2016
DAL 16-01: Pneumococcal Vaccines Update

Dear Chief Executive Officer:

The New York State Department of Health (Department) is issuing this letter to offer guidance on how recent changes to the standard of care regarding pneumococcal vaccination of adults 65 years of age and older impact legal requirements for vaccination of admitted patients. New York State (NYS) Public Health Law (PHL) §2805-h requires hospitals to offer pneumococcal vaccination to all admitted patients 65 years of age and older unless such patient has already received the vaccination, is not in need of a booster, or is a person for whom it is medically contraindicated. For compliance with this statutory requirement, the Department recommends hospitals follow the Advisory Committee on Immunization Practices (ACIP) most current recommendations for vaccination against pneumococcal disease. ACIP recommendations constitute the medical standard of care for vaccination in the United States and are endorsed by the Centers for Disease Control and Prevention and harmonized with recommendations of the American College of Physicians and the American Academy of Family Physicians.

The new ACIP 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, according to the schedule described below.

  • 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.
  • The two vaccines must not be co-administered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.
  • If a patient has previously received PPSV23, the minimum interval to receive PCV13 is one year.
  • 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.

Although PHL §2805-h does not require hospitals to offer pneumococcal vaccine to patients less than 65 years of age, hospitals are reminded that the ACIP also recommends pneumococcal vaccination of certain high-risk adults aged 19-64 years.

  • 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
    • candidates for or recipients of 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:
    • o immunocompromised conditions (e.g., HIV infection)
    • o chronic renal failure or nephrotic syndrome
    • o functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)

The Department recommends hospitals take the following steps immediately:

  • Revise their current immunization policies and adopt the attached non-patient specific standing orders to ensure that all admitted patients aged 65 years and older are screened and offered the appropriate pneumococcal vaccine and are advised, as part of discharge planning, to schedule appointments with their primary care providers for the second dose of pneumococcal vaccine where indicated.
  • Implement policies and procedures to ensure that immunization histories of all admitted patients 65 years of age or older are routinely reviewed in the New York State Immunization Information System (NYSIIS) if vaccinated outside of New York City (NYC) or the Citywide Immunization Registry (CIR) if vaccinated within NYC, the electronic health record (EHR), and/or the regional health information organization (RHIO), where available
    • o Hospitals should work with their EHR and/or RHIO to implement data exchange with NYSIIS and/or the CIR in order to facilitate immunization history review and reporting.
    • o The Department also urges providers to obtain consent from all adult patients for reporting all doses of vaccine administered 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 this letter may be directed to the New York State Department of Health Bureau of Immunization at (518) 473-4437 or to the New York State Department of Health Office of Primary Care and Health Systems Management at (518) 402-1004.


Ruth Leslie
Division of Hospitals and Diagnostic & Treatment Centers
Office of Primary Care and Health Systems Management
Elizabeth Rausch-Phung, M.D., M.P.H.
Bureau of Immunization
Office of Public Health


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