Vaccinating Patients with Work-Related Asthma
Which vaccine should a 60-year-old patient with work-related asthma, but no iatrogenic immunodeficiency, receive?
a. a single dose of the 13-valent pneumococcal conjugate vaccine
b. multiple doses of the 13-valent pneumococcal conjugate vaccine
c. a single dose of the 23-valent pneumococcal polysaccharide vaccine
d. multiple doses of the 23-valent pneumococcal polysaccharide vaccine
Answer: c
Adults with work-related asthma (WRA) who are younger than 65 years of age should receive a single dose of the 23-valent pneumococcal polysaccharide vaccine, according to a recent report issued by the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH). Younger patients with WRA should not receive the 13-valent pneumococcal conjugate vaccine, unless they have underlying iatrogenic immunodeficiency or other immunosuppressing medical conditions.
The report said adults who do need the 13-valent pneumococcal conjugate vaccine should receive a single dose at least a year before or after receiving the 23-valent pneumococcal polysaccharide vaccine.
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Only 54% of adults with WRA receive the pneumococcal vaccine, according to the report. That coverage rate is below the 60% goal set by the federal government’s Healthy People 2020 initiative, according to Katelynn Dodd, MPH, the report’s lead author and an epidemiologist in the respiratory health division of NIOSH (doi: https://dx.doi.org/10.1016/j.amepre.2017.07.022).
Why don’t more patients who need the vaccine receive it? Dr. Dodd and her colleague said a host of factors are at work, including a lack of awareness among patients and providers about both the risk of pneumonia and the importance of vaccination. More importantly, what can be done to reverse the trend? The report highlighted pneumococcal vaccination coverage in Ohio, which had the highest of the 29 states assessed by the report’s authors. In Ohio, healthcare providers are required to offer the vaccine to every hospitalized patient.
A standing order for vaccination could increase providers’ awareness of national immunization guidelines and increase the number of eligible patients who receive the vaccine, according to the report. The report said improved patient education and alerting physicians to patients’ vaccination status through electronic health records can improve coverage among high-risk individuals. Dr. Dodd also recommended that healthcare providers confirm that patients with asthma have received the vaccine, and offer it those who have not yet been vaccinated.
—Dan Cook
