Does a 72-year-old patient with diabetes qualify for Prevnar 20 (Pneumococcal conjugate vaccine) in Ontario if they received Pneumovax 23 (Pneumococcal polysaccharide vaccine) 5 years ago?

Pneumococcal Vaccination for a 72-Year-Old Diabetic Patient in Ontario

Yes, a 72-year-old patient with diabetes qualifies for Prevnar 20 (PCV20) in Ontario if they received Pneumovax 23 (PPSV23) 5 years ago. 1

Recommendation Based on Current Guidelines

For adults aged ≥65 years who previously received only PPSV23, the Advisory Committee on Immunization Practices (ACIP) recommends:

• A single dose of PCV20 should be administered ≥1 year after the last PPSV23 dose 1
• This recommendation applies to adults with chronic medical conditions including diabetes 1

Rationale for PCV20 Administration

• Diabetes is considered a chronic medical condition that increases risk for pneumococcal disease 1, 2
• PCV20 provides coverage against 20 pneumococcal serotypes, expanding protection beyond the previous vaccination 1
• The 5-year interval since the patient's last PPSV23 exceeds the minimum required 1-year interval between PPSV23 and subsequent PCV20 1

Clinical Evidence Supporting This Recommendation

• PCV20 has demonstrated robust immune responses in adults ≥65 years previously vaccinated with PPSV23 3
• A phase 3 clinical trial showed that PCV20 was well tolerated and immunogenic in adults ≥65 years with prior pneumococcal vaccination 3, 4
• Diabetic elderly have shown reduced risk of invasive pneumococcal disease with pneumococcal vaccination 2

Implementation Considerations

• The patient should receive a single dose of PCV20 since it has been ≥1 year since their PPSV23 dose 1
• No additional pneumococcal vaccines are needed after PCV20 administration in this scenario 1
• This recommendation aligns with the goal of reducing morbidity and mortality from pneumococcal disease in high-risk older adults 1

Common Pitfalls to Avoid

• Waiting too long: Don't delay vaccination in eligible patients, as adults ≥65 years with diabetes have increased risk of pneumococcal disease 2
• Unnecessary revaccination: After receiving PCV20, no additional pneumococcal vaccines are needed 1
• Incorrect intervals: Ensure at least 1 year has passed since the last PPSV23 dose before administering PCV20 (which is satisfied in this case) 1

The most recent ACIP recommendations clearly support providing PCV20 to this patient, as they meet both age criteria (≥65 years) and have a qualifying chronic medical condition (diabetes), with an appropriate interval (5 years) since their previous PPSV23 vaccination 1.