Pneumococcal Vaccination Status for Older Adults

Percentage of patients 66 years of age and older who have received a pneumococcal vaccine

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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 percent 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).

Adults aged >=65 years who have not previously received 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).

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2015a, June 10). Pneumococcal Disease: Symptoms and Complications.  Retrieved from https://www.cdc.gov/pneumococcal/about/symptoms-complications.html'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2015b, June 19). Pneumococcal Vaccination: Clinical Features. Retrieved from https://www.cdc.gov/pneumococcal/clinicians/clinical-features.html#pneumonia'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2019, November 21). Pneumococcal Vaccination: What Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html.'

Reference Type: CITATION

Reference Text: 'Chen, J., O’Brien, M. A., Yang, H. K., et al. (2014). Cost-Effectiveness of Pneumococcal Vaccines for Adults in the United States. Advances in Therapy, 31(4), 392-409.'

Reference Type: CITATION

Reference Text: 'Janssens, J. P., & Krause, K. H. (2004). Pneumonia in the very old. Lancet Infectious Diseases, 4(2), 112-124.'

Reference Type: CITATION

Reference Text: '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;71:109–117. DOI:  http://dx.doi.org/10.15585/mmwr.mm7104a1external icon'

Reference Type: CITATION

Reference Text: 'Matanock, A., G. Lee, R. Gierke, M. Kobayashi, A. Leidner, T. Pilishvili. 2019. “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ?65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices.” MMWR Morb Mortal Wkly Rep 68:1069–75.'

Reference Type: CITATION

Reference Text: 'Thomas, C.P., M. Ryan, J.D. Chapman, et al. 2012. “Incidence and Cost of Pneumonia in Medicare Beneficiaries.” Chest 142(4): 973–81.'

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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 eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Patients 66 years of age and older at the start of the measurement period with a visit during the measurement period

Equals Initial Population

Exclude patients who are in hospice care for any part of the measurement period

Patients who received a pneumococcal vaccination on or after their 60th birthday and before the end of the measurement period

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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