At its June 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) approved 2 recommendations: (1) a dose of PCV13 (pneumococcal conjugate vaccine-13 serotypes; Prevnar13, Pfizer Inc, New York, New York), in combination with PPSV23 (pneumococcal polysaccharide vaccine-23 serotypes; Pneumovax, Merck & Co Inc, Whitehouse Station, New Jersey) for individuals aged 19 years or older who are immunocompromised¹ and (2) the 2012-2013 influenza recommendations for children aged 6 months to 8 years.² What do these recommendations mean for health care providers? 

Patients aged 19 years or older who have functional or anatomic asplenia, immunocompromising conditions, congenital or acquired immunodeficiency, human immunodeficiency virus infection, chronic renal failure or nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, diseases requiring treatment with immunosuppressive drugs such as long-term corticosteroids or radiotherapy, solid organ transplantation, multiple myeloma, cerebrospinal fluid leaks, or cochlear implants are candidates for both PPSV23 and PCV13. Although the US Food and Drug Administration approved PCV13 for children aged 6 weeks through 5 years in 2010³ and for adults aged 50 years or older in 2011,⁴ the ACIP—after review of the research—believed the evidence supported the use of PCV13 for individuals listed above aged 19 years or older. 

There are 2 categories of patients: (1) patients who have not received PPSV23 and (2) patients who have received PPSV23. For those who have not previously received PPSV23, PCV13 should be given first, at least 8 weeks before PPSV23 is administered. Individuals who have previously received PPSV23 should be given PCV13 one year after last dose of PPSV23. For persons with functional or anatomic asplenia and for persons with immunocompromising conditions, a second dose of PPSV23 is recommended 1 or more years after PCV13 and 5 or more years after the first dose of PPSV23. 

The 2012-2013 influenza vaccine will contain the 2009 pandemic H1N1 strain, but the H3N2 and B strains will be replaced. The H3N2 component is changing from A/Perth/16/2009 to A/Victoria/361/2011, and the B component is changing from the Victoria-lineage B/Brisbane/60/2008 to the Yamagata-lineage B/Wisconsin/1/2010. Because 2 doses of influenza vaccine are required to adequately stimulate a young child's immune system, the ACIP approved the following algorithm for children aged 6 months to 8 years: 

Trivalent influenza vaccine injectable is a killed virus and has been approved starting at age 6 months. Live attenuated influenza virus in nasal spray formula has been approved starting at age 2 years. Osteopathic physicians should consider these new ACIP recommendations as the influenza season arrives.