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High risk patients are on your records, but are they on your radar?
Pneumococcal
Pneumococcal
disease:
disease: Give your
most
most vulnerable
patients a shot
patients
P
neumococcal infections can cause serious diseases including
bacteraemia, meningitis and pneumonia. Prevenar 13 ®
(Pneumococcal polysaccharide conjugate vaccine, 13-valent
absorbed) is used regularly in infants as part of the Australian National
Immunisation Program (NIP), 1 but it may not be common knowledge
that Prevenar 13 is also indicated for use in adults. 2
Adults become more susceptible to infections like
pneumococcal disease when they have conditions which
compromise their immune system 3 .
The Australian Immunisation Handbook (AIH) is the
most informed resource for identifying at-risk patients and
understanding which vaccines are recommended. 1
The AIH defines conditions associated with the highest risk of
invasive pneumococcal disease (IPD) as Category A conditions: 1
Asplenia e.g. splenectomy
Functional asplenia
e.g. sickle cell disease
Haematopoietic
stem cell transplant
Chronic renal failure or
relapsing/persistent
nephrotic syndrome
Intracranial shunts
Haematological and
other malignancies
HIV/AIDS
Solid organ transplant
Congenital or acquired immune
deficiency
Immunosuppressive therapy (including
corticosteroid therapy ≥ 2 mg/kg per
day of prednisolone or equivalent for
> 1 week) or radiation therapy, where
sufficient immune reconstitution for
vaccine response is expected
Cerebrospinal fluid (CSF) leak
Cochlear implants
Pneumococcal vaccines, including Prevenar 13, are recommended
for these patients. Prevenar 13 is recommended upon diagnosis, 1
but it may not be this straightforward in daily practice. Your
patients may have been diagnosed with their condition some
time ago, received another pneumococcal vaccine previously,
be unaware of their vaccination status, or even missed out on
vaccination altogether.
Nurses make a difference by championing vaccination
Successful nurse-led vaccination initiatives include:
• Screening and identification programs 4,5
• Telephone reminders +/- face-to-face reminders 6
• Electronic health record reminders 7
• Pre-visit care planning for preventative health 7
• Standing orders 8,9
Growing evidence shows a combination of interventions
integrating vaccination checks into routine clinical care increases
vaccination uptake. 6,9,10
A combination of strategies can help protect your most
vulnerable patients against pneumococcal disease
You can:
• Use your patient management system to screen and identify
your patients with Category A conditions.
• Use the PneumoSmart Vaccination Tool to help navigate
the pneumococcal vaccine recommendation pathway. Input
patient information via www.pneumosmart.org.au/clinicians/
vaccination-tool/ to determine what pneumococcal vaccine
they need, and when.
• Integrate this into your recall/reminder systems to ensure
pneumococcal vaccination status is discussed at their next
appointment.
• Document vaccines administered in the Australian
Immunisation Register (AIR). For patients with compromised
immune systems and multiple touchpoints within the health
system it’s critical their records are up-to-date.
Nurses are in an ideal position to help protect vulnerable adult
patients against pneumococcal disease. Using a multicomponent,
collaborative approach in advocating pneumococcal vaccination
is helpful – by establishing systems in your practice to prevent
patients falling through the cracks, updating all practice staff
on vaccine recommendations, administering the vaccines,
documenting in the AIR and in providing patient education.
This article is supported by Pfizer.
For PBS information refer to the primary advertisement in this publication
BEFORE PRESCRIBING, PLEASE REVIEW THE PRODUCT INFORMATION AVAILABLE IN THE PRIMARY ADVERTISEMENT IN THIS PUBLICATION .
Limited safety and immunogenicity data on PREVENAR 13 are available for patients with sickle cell disease, allogeneic haematopoietic
stem cell transplant, or HIV infection, and are not available for other immunocompromised patient groups. Efficacy/effectiveness has
not been established. Vaccination should be considered on an individual basis. Immunocompromised individuals or individuals with
impaired immune responsiveness due to the use of immunosuppressive therapy may have a reduced antibody response to PREVENAR
13. Immunisation schedules for PREVENAR 13 should be based on official recommendations. References: 1. Australian Technical Advisory
Group on Immunisation (ATAGI). The Australian Immunisation Handbook 10th Ed (2017 Update). Canberra: Australian Government
Department of Health, 2017. Available at www.immunise.health.gov.au. Accessed September 2017. 2. PREVENAR 13® Approved Product
Information. 3. National Centre for Immunisation Research and Surveillance, Adult Vaccination factsheet. Available at http://www.ncirs.
edu.au/assets/provider_resources/fact-sheets/adult-vaccination-fact-sheet.pdf. Accessed September 2017. 4. Serre J, et al. Eur J Intern
Med. 2017; pii: S0953-6205(17)30220-0. 5. Byrnes P, et al. Aust Fam Physician. 2006; 35(7):551-2. 6. Chan SS, et al. Int J Nurs Stud. 2015;
52(1):317-24. 7. Wright WL, et al. J Am Assoc Nurse Pract. 2017; 29(7):384-391. 8. Rhew DC, et al. J Gen Intern Med 1999;14:351–356. 9.
Rittle C and Francis R, American Nurse Today 2016; 11(9):42-43. 10. Koch JA, J Gerontol Nurs. 2012; 38(2):31-9.
®Registered trademark. Pfizer Australia Pty Limited, 38–42 Wharf Road, West Ryde, NSW 2114. PP-PNA-AUS-0105. PFAPRE2412. 09/17. GHG.
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