Pneumococcal Vaccination Status for Older Adults

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This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Pneumococcal disease is a common cause of illness and death in older adults and in persons with certain underlying conditions. The major clinical syndromes of pneumococcal disease include pneumonia, bacteremia and meningitis, with pneumonia being the most common (CDC, 2015a). Pneumonia symptoms generally include fever, chills, pleuritic chest pain, cough with sputum, dyspnea, tachypnea, hypoxia tachycardia, malaise and weakness. There are an estimated 400,000 cases of pneumonia in the U.S. each year and a 5%–7% mortality rate, although it may be higher among older adults and adults in nursing homes (CDC, 2015b; Janssens and Krause, 2004).

Pneumococcal infections result in significant health care costs each year. Geriatric patients with pneumonia require hospitalization in nearly 90% of cases, and their average length of stay is twice that of younger adults (Janssens and Krause, 2004). Pneumonia in the older adult population is associated with high acute-care costs and an overall impact on total direct medical costs and mortality during and after an acute episode (Thomas et al., 2012). Total medical costs for Medicare beneficiaries during and one year following a hospitalization for pneumonia were found to be $15,682 higher than matched beneficiaries without pneumonia (Thomas et al., 2012). It was estimated that in 2010, the total annual excess cost of hospital-treated pneumonia in the fee-for-service Medicare population was approximately $7 billion (Thomas et al., 2012).

Pneumococcal vaccines have been shown to be highly effective in preventing invasive pneumococcal disease. Studies show that at least one dose of pneumococcal polysaccharide vaccine protects between 50-85 in 100 healthy adults against invasive pneumococcal disease (CDC, 2019). When comparing costs, outcomes and quality adjusted life years, immunization with recommended pneumococcal vaccines was found to be more economically efficient than no vaccination, with an incremental cost-effectiveness ratio of $25,841 per quality-adjusted life year gained (Chen et al., 2014).

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Adults aged >=65 years who have not previously received pneumococcal conjugate vaccine (PCV) or whose previous vaccination history is unknown should receive 1 dose of PCV (either PCV20 or PCV15). Adults aged 19–64 years with certain underlying medical conditions or other risk factors who have not previously received PCV or whose previous vaccination history is unknown should receive 1 dose of PCV (either PCV20 or PCV15).

Dosing schedule for PCV15: When PCV15 is used, it should be followed by a dose of PPSV23. The recommended interval between administration of PCV15 and PPSV23 is >=1 year. A minimum interval of 8 weeks can be considered for adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak to minimize the risk for IPD caused by serotypes unique to PPSV23 in these vulnerable groups.

Adults with previous PPSV23 only: Adults who have only received PPSV23 may receive a PCV (either PCV20 or PCV15) >=1 year after their last PPSV23 dose. When PCV15 is used in those with history of PPSV23 receipt, it need not be followed by another dose of PPSV23.

Adults with previous PCV13: The incremental public health benefits of providing PCV15 or PCV20 to adults who have received PCV13 only or both PCV13 and PPSV23 have not been evaluated. These adults should complete the previously recommended PPSV23 series (Kobayashi et al., 2022). The CDC further clarifies that the previous pneumococcal recommendations remain in effect pending further evaluation and recommends using the following information for guidance on the number of and interval between any remaining recommended doses of PPSV23 following previous receipt of PCV13 (CDC, 2022).

- For adults 65 years or older without an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant, CDC recommends 1 dose of PPSV23 [1] at age 65 years or older. Administer a single dose of PPSV23 at least 1 year after PCV13 was received. Their pneumococcal vaccinations are complete.

- For adults 19 years or older with a cerebrospinal fluid leak or cochlear implant, CDC recommends 1 dose of PPSV23 [1] before age 65 years and 1 dose of PPSV23 [1] at age 65 years or older. Administer a single dose of PPSV23 at least 8 weeks after PCV13 was received. If the adult is 65 years or older, their pneumococcal vaccinations are complete. If the adult was younger than 65 years old when the first dose of PPSV23 was given, then administer a final dose of PPSV23 once they turn 65 years old and at least 5 years have passed since PPSV23 was first given. Their pneumococcal vaccinations are complete.

- Adults 19 years or older with an immunocompromising condition, CDC recommends 2 doses of PPSV23 [1] before age 65 years and 1 dose of PPSV23 [1] at age 65 years or older. Administer a single dose of PPSV23 at least 8 weeks after PCV13 was received. If the patient was younger than 65 years old when the first dose of PPSV23 was given and has not turned 65 years old yet, administer a second dose of PPSV23 at least 5 years after the first dose of PPSV23. This is the last dose of PPSV23 that should be given prior to 65 years of age. Once the patient turns 65 years old and at least 5 years have passed since PPSV23 was last given, administer a final dose of PPSV23 to complete their pneumococcal vaccinations.

[1] For adults who have received PCV13 but have not completed their recommended pneumococcal vaccine series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available. If PCV20 is used, their pneumococcal vaccinations are complete.