Uptake of 13-Valent Pneumococcal Conjugate Vaccine among US Adults Aged 19 to 64 Years with Immunocompromising Conditions

The CDC Advisory Committee on Immunization Practices (ACIP) recommended immunization with the recently licensed 13-valent pneumococcal conjugate vaccine (PCV13) for high-risk (immunocompromised) adults aged ≥19 years in 2012. This was in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Data on vaccine-specific uptake among these individuals were previously unavailable. This retrospective observational study analyzed PCV13 uptake in immunocompromised patients aged 19–64 years. Data were acquired from insurance claims (N = 267,022) and electronic health records (EHR; N = 572,055) from October 2011–October 2016. Descriptive statistics were provided. Demographics were similar across the two database cohorts: mean age 49.7–51.0 years, 57–62% female, and >70% white. Iatrogenic immunosuppression was the most common high-risk category (33.3–44.2%). PCV13 uptake was 7.3% (95% CI: 7.25–7.45) in insurance claims and 9.9% (95% CI: 9.80–9.96) in EHR. Patients with HIV had the highest rate of PCV13 uptake; patients with multiple risk factors were above the mean in both cohorts. A Kaplan-Meier analysis was conducted to include patients lost to follow-up, with 441,657 and 722,071 patients for insurance claims and EHR, respectively. PCV13 uptake was only slightly higher: 9.3% (95% CI: 9.14–9.47) and 13.1% (95% CI: 12.93–13.19) for insurance claims and EHR, respectively. Four years after the ACIP 2012 recommendation, PCV13 uptake in high-risk adults aged19–64 years was low at <15% in all overall analyses. Clinicians caring for these patients should ensure adherence to the ACIP recommendation to minimize the risk of pneumococcal disease

Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine in patients with immunocompromising conditions: a review of available evidence

Immunocompromising conditions increase the risk of invasive pneumococcal disease (IPD). Vaccine uptake in patients with these conditions may be low in part because of concerns about decreased immunogenicity and safety in these high-risk groups. We conducted a literature search to identify publications describing antibody responses to 13-valent pneumococcal conjugate vaccine (PCV13) in immunocompromised individuals recommended for PCV13 vaccination by the US Advisory Committee on Immunization Practices (ACIP). This review summarizes immunogenicity data from 30 publications regarding the use of PCV13 comprising 2406 individuals considered at high risk for IPD by the ACIP. Although antibody responses to PCV13 in individuals with immunocompromising and high-risk conditions were variable and generally lower compared with healthy controls, the vaccine was immunogenic and was largely well tolerated. Based on these findings, concerns regarding immunogenicity and safety of PCV13 are not supported and should not be barriers to vaccination in high-risk populations

Getting SET for Student Success: Foundations for a Student Education Team.

BACKGROUND: Family medicine clinical education poses logistic issues that we sought to address with the Student Education Team model. METHODS: The model combined team-based, patient-centered care with student experiences in a sustainable precepting model. Four learners successfully underwent precepting simultaneously. Schedulers booked patients in the team schedule, and the patients knew they would see a student and a faculty team member. RESULTS: The Student Education Team model increased the learner to preceptor ratio compared to traditional precepting models. Use of the team increased the number of learners completing rotations. The team schedule nearly eliminated patients refusing student involvement and enhanced throughput because patients saw the most readily available staff. DISCUSSION: The team offered clinicians and learners a model for incorporating learning into clinicians\u27 schedules