The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What’s New entries are at the top of each subsection.

GENERAL GERIATRICS

New pneumococcal vaccination recommendations for adults ≥65 years old (November 2019)

The United States Advisory Committee on Immunization Practices has updated its pneumococcal vaccination recommendations for adults ≥65 years old [1]. The committee continues to recommend routine vaccination with the 23-valent pneumococcal vaccine (PPSV23) for all adults in this age group. Shared decision making is now recommended to determine whether the 13-valent pneumococcal conjugate vaccine (PCV13) should be given in addition to PPSV23 for adults ≥65 years old who otherwise lack an indication for both vaccines (eg, an immunocompromising condition). The change from the prior recommendations to give both vaccines to all persons in this age group is based on the dramatic decline in the incidence of PCV13-type infections resulting from universal PCV13 vaccination in childhood. We concur with this new recommendation. For most otherwise healthy adults ≥65 years old, we consider the absolute risk of acquiring pneumococcal disease caused by a PCV13 serotype to be low, and the expected benefit of the additional vaccination is very small. (See “Pneumococcal vaccination in adults”, section on ‘Adults, ages 65 years or older’.)

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