Lucio Volino, PharmD, FAPhA, RUCIF, NCNTT

Panelists discuss how pharmacists should implement follow-up practices for patients who need additional pneumococcal vaccine doses, including scheduling appointments while patients are present, using text or phone reminders, queuing future vaccine prescriptions in computer systems to align with due dates, utilizing state immunization registries for tracking and alerts when available, and providing patients with vaccination records in their preferred format while ensuring compliance with state information-sharing requirements to guarantee complete protection through proper series completion.

Panelists discuss how pharmacists can systematically identify eligible patients through team-based approaches involving technicians and student pharmacists who can query databases by age (50+) and high-risk conditions or medications, while addressing common barriers identified in research including insurance coverage, patient willingness, eligibility determination challenges, documentation time, and patient demand—emphasizing that effective solutions require clear communication, strong provider recommendations rather than just offering eligibility, community outreach, and creating pharmacy cultures where vaccination is integrated into workflow rather than treated as a separate process.

Panelists discuss how pharmacists should educate patients about pneumococcal vaccines by providing current vaccine information statements (VIS) updated May 29, 2025, explaining common adverse effects like injection site reactions and mild systemic symptoms as normal immune responses, conducting thorough pre-vaccination screening for moderate-to-severe illness, allergies to vaccine components (noting that conjugated vaccines contain yeast), and history of fainting or anxiety, while emphasizing the importance of transparent communication and careful review of screening questions to minimize risks and maximize vaccine benefits.

Panelists discuss how patients who previously completed pneumococcal vaccination with both PCV-13 and PPSV-23 may benefit from additional conjugate vaccine coverage with PCV-20 or PCV-21, with specific timing recommendations based on age and risk factors—including waiting at least 5 years after the last dose for high-risk patients under 50, following age-based recommendations for those turning 50, and using shared clinical decision-making for patients 65 and older who received PPSV-23 at or after age 65, where individual risk assessment considering underlying conditions, time since last vaccination, and exposure risk guides the collaborative decision between patient and pharmacist.

Panelists discuss how pharmacists should ensure patients receive at least one conjugated pneumococcal vaccine (PCV-15, PCV-20, or PCV-21) as the foundation of protection, with subsequent vaccine sequencing depending on which initial vaccine was given—where PCV-15 recipients should receive PPSV-23 one year later for additional serotype coverage, patients with prior PCV-13 need PCV-20 or PCV-21 after a one-year interval, and immunocompromised patients or those with cochlear implants/CSF leaks can have shortened intervals of 8 weeks between doses due to their higher risk for serious disease.

Panelists discuss how ACIP's decision to lower the pneumococcal conjugate vaccine age recommendation from 65 to 50 years was supported by evidence showing that 33-54% of adults aged 50-64 already had risk factors for vaccination, nearly 90% of those hospitalized with pneumococcal disease in this age group had at least one risk condition, mortality rates between the 50-64 and 65+ age groups had become comparable, and age-based recommendations are easier to implement than risk-based approaches, though vaccination coverage remains low at less than 40% among eligible adults with risk factors.

Panelists discuss how pneumococcal vaccines differ between conjugated vaccines (PCV-15, PCV-20, PCV-21) and polysaccharide vaccines (PPSV-23) in terms of immune response mechanisms and serotype coverage, with current CDC recommendations now including all adults aged 50 and older for vaccination while maintaining risk-based recommendations for adults 19-49 years with underlying conditions such as immunocompromising diseases, chronic heart/lung/liver disease, diabetes, alcohol use disorder, and cigarette smoking.

Panelists discuss how pneumococcal disease affects adults through both non-invasive infections like pneumonia and invasive pneumococcal disease (IPD), with current U.S. data showing over 33,000 IPD cases and 3,600 deaths in 2023, particularly impacting adults aged 50 and older who face increased risk due to age-related immunosenescence and underlying medical conditions such as compromised immune systems, chronic diseases, and social factors like crowded living environments.