Jennifer

Gregory
Pharm. D. Candidate 2016
January 28, 2015

Objectives
Given a patients health history and age, determine whether they should receive a pneumococcal vaccination
according to the new recommendations.
Discuss one limitation of Rapid Influenza Diagnostic Testing.
Given an influenza patient case, determine whether that patient should be a candidate for antiviral therapy.

Prevention1-6

Triaging patients: Severe symptoms

Difficulty breathing
Chest/abdominal pain
Dizziness
Confusion
Severe vomiting

Influenza vaccine: Continue to advocate

Patients > 6 months

Pneumococcal
vaccine: New adult recommendations
Patients 65 years

Patients
19-64 and immunocompromised

Diagnosis6,7

Rapid Influenza Diagnostic Test

Encouraged
to utilize

<15 minutes for results
Decision
to treat based foremost on clinical evaluation

Not needed for every patient
Helpful in patients with respiratory illness
Helpful when results will influence a clinical

decision

Negative results do not rule out influenza

False-positives/ true-negatives
Greater during low prevalence of disease
False-negatives/ true-positives
Greater during high prevalence of disease

Treatment2,6,8-10
Antiviral
Tamiflu
(oseltamivir)
Relenza
(zanamivir)

Route of Admin.
& Dosage
Oral, liquid;
75 mg bid
Inhaled powder;
5mg inhalation bid

Common Side Effects

Considerations

Nausea, vomiting, abdominal

pain
Cough, nasal symptoms, pain in
throat

Approved for individuals 2 weeks; preferred

choice for pregnant women & hospitalized patients
Approved for individuals 7 yrs; not
recommended in patients with respiratory,
cardiac, or severe influenza disease

Antiviral Therapy Recommendations

1. High-risk patients should b e treated as soon as possible
Immunocompromised

i.e. young children, adults 65 years
Progressive, chronic illness
Hospitalized
Nursing-home/ chronic care facility
Pregnant

2. High risk patients may benefit if treated

>48 hours from symptom onset
3. Clinical judgment for healthy
outpatients with symptom onset 48
hours

2
1

Pneumococcal Vaccine Protocol for Adults3,4

wait at least 1 year following PPSV23 t o a dminister PCV13

wait a t least 5 years following last PPSV23 to administer next P PSV23

patient should r eceive a nother dose of PPSV23 at age 65 years o r o lder
PCV13 and PPSV23 should not be a dministered on the same day.

yes

*Immunocompromised?

yes

no

Asthma, smoker, resident

yes
no
of nursing home or long- no
Receive Receive PPSV23 as adult?

term care?
No vaccine
PPSV23
yes
no
yes

as adult? Administer Administer Receive PPSV23 as adult? yes

yes no PCV13, wait PCV13, w ait
no

Administer PPSV23 No vaccine

No vaccine Administer 8 weeks,
8 weeks,
PPSV23 administer administer
PPSV23
PPSV23
Receive PCV13?

wait a t least 1 year following PCV13 t o a dminister PPSV23

Adult 19-64?

Adult 65?
yes
Receive
PCV13?
yes
no


Receive
Receive
PPSV23 as
PPSV23 as

adult?
adult?
yes

no yes
no
Administer Administer Administer Administer
PCV13, wait PCV13, wait
PPSV23 PPSV23
6-12 months,
6-12
administer months,
PPSV23 administer
PPSV23

wait a t least 8 weeks following PCV13 t o administer PPSV23

wait at least 1 year following PPSV23 t o a dminister PCV13

wait a t least 5 years following last PPSV23 to administer next P PSV23

*Immunocompromised consists of the following: cerebrospinal fluid (CSF) leaks, cochlear implant(s), sickle cell disease and
other hemaglobinopathies, functional or anatomic asplenia, congenital or a cquired immunodeficiencies, HIV infection, chronic
renal failure, nephrotic syndrome, leukemia, hodgkin disease, generalized malignancy, long-term immunosuppressive therapy,
solid organ transplant, multiple myeloma, heart disease, lung disease, diabetes, alcoholism, cirrhosis
PCV13 and PPSV23 should not be a dministered on the same day.

References
1.

American Diabetes Association. Flu and Pneumonia Shots [Internet]. Alexandria (VA): American
Diabetes Association. 2014 Aug 29 [updated 2013 Jun 7; cited 2015 Jan 23]. Available from:
http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/other-
treatments/flu-and-pneumonia-shots.html
2. Campbell, A. 2014-2015 Influenza Activity and Antiviral Recommendations: Clinical Outreach and
Communication Activity Webinar [Internet]. Atlanta: Center for Disease Control. 2015 Jan 14 [cited
2015 Jan 23]. Available from:
http://emergency.cdc.gov/coca/ppt/2015/01_14_15_influenza_antiviral.pdf
3. Centers for Disease Control and Prevention [Internet]. Atlanta: Center for Disease Control. PCV13
(Pneumococcal Conjugate) Vaccine; 2014, Dec 10 [cited 2015 Jan 23]; [about 2 screens]. Available
from: http://www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm
4. Centers for Disease Control and Prevention [Internet]. Atlanta: Center for Disease Control.
Pneumococcal Vaccine: Who Needs It?; 2014, Sept 18 [cited 2015 Jan 23]; [about 2 screens].
Available from: http://www.cdc.gov/vaccines/vpd-vac/pneumo/vacc-in-short.htm
5. Is the Flu a reason to go the emergency room? [Internet]. Harrisburg (PA): Pennsylvania Medical
Society; 2013 Jan 15 [updated 2013 Nov 5; cited 2015 Jan 23]. Available from:
http://www.pamedsoc.org/MainMenuCategories/Patient-Care-Quality/Health-Media/Flu-ER.html
6. Erlikh IR, Abraham S, Kondamudi VK. Management of Influenza. American Family Physician
[Internet]. 2010 Nov 1 [cited 2015 Jan 23];82(9):1087-95. Available from:
http://www.aafp.org/afp/2010/1101/p1087.html
7. Centers for Disease Control and Prevention [Internet]. Atlanta: Center for Disease Control. Rapid
Diagnostic Testing for Influenza: Information for Clinical Laboratory Directors; 2014 Nov 5 [cited
2015 Jan 23]; [about 2 screens]. Available from:
http://www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm
8. MICROMEDEX [Internet]. Version 2.0. Greenwood Village (CO): Truven Health Analytics. c1974.
Tamiflu; [cited 2015 Jan 23]; [about 1 screen]. Available from: http://0-
www.micromedexsolutions.com.libcat.ferris.edu
9. MICROMEDEX [Internet]. Version 2.0. Greenwood Village (CO): Truven Health Analytics. c1974.
Relenza; [cited 2015 Jan 23]; [about 1 screen]. Available from: http://0-
www.micromedexsolutions.com.libcat.ferris.edu
10. Centers for Disease Control and Prevention [Internet]. Atlanta: Center for Disease Control. CDC
Expert Commentaries on Medscape. 2015 Jan 5 [cited 2015 Jan 23]; [about 1 screens]. Available
from: http://www.cdc.gov/flu/freeresources/media-medscape.htm
11. Image by Liberty Voice. Available from: http://guardianlv.com/2013/09/influenza-vaccine-a-
miracle-drug-coming