23-valent pneumococcal polysaccharide vaccine (PPSV23)

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September 9, 2010 ¡ª Guidelines have been updated for use of the

23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults,

according to a report in the September 3 issue of MMWR. Morbidity and Mortality

Weekly Report.

" Invasive disease from Streptococcus pneumoniae (pneumococcus)

is a major cause of illness and death in the United States, with an

estimated 43,500 cases and 5,000 deaths among persons of all ages in

2009, " write J. P. Nuorti, MD, DSc, and C. G. Whitney, MD, from the

Division of Bacterial Diseases, National Center for Immunization and

Respiratory Diseases, US Centers for Disease Control and Prevention, for

the Advisory Committee on Immunization Practices (ACIP) Pneumococcal

Vaccines Working Group. " This report provides updated recommendations

from the ...ACIP for prevention of invasive pneumococcal disease (IPD)

(i.e., bacteremia, meningitis, or infection of other normally sterile

sites through use of the ...PPSV23 among all adults aged ¡Ý65 years and

those adults aged 19¨C64 years with underlying medical conditions that

put them at greater risk for serious pneumococcal infection. "

Compared with the 1997 ACIP recommendations, the new guidelines now

include smoking and asthma as indications for which PPSV23 vaccination

is recommended. Furthermore, routine use of PPSV23 is no longer

recommended for Alaska Natives or American Indians younger than 65 years

unless they have medical or other indications for PPSV23.

ACIP recommendations remain unchanged regarding revaccination with

PPSV23 among the adult patient groups at greatest risk for IPD, namely

those with functional or anatomic asplenia and those with

immunocompromising conditions. The updated guidelines do not address

ACIP recommendations for preventing pneumococcal disease among infants

and youths 18 years or younger using the 13-valent pneumococcal

conjugate vaccine and PPSV23; these recommendations are published

separately.

Updated Recommendations

Specific updated ACIP recommendations for administration of PPSV23 among adults

19 years or older include the following:

Adults aged 19 to 64 years with chronic or immunosuppressive medical conditions,

including asthma, should receive PPSV23.For adults aged 19 to 64 years who smoke

cigarettes, PPSV23 administration and smoking cessation guidance are

recommended.Unless there are medical indications for

PPSV23, routine administration of PPSV23 is no longer recommended for

Alaska Natives or American Indians younger than 65 years. However, for

Alaska Natives and American Indians aged 50 to 64 years who reside in

areas where the risk for IPD is increased, public health authorities may

recommend PPSV23 administration in certain situations.At age 65 years, all

persons should receive

PPSV23 vaccination. Persons given PPSV23 for any indication before age

65 years should be given another dose of PPSV23 at 65 years or older if 5

years or more have passed since their previous dose. Persons who

receive PPSV23 at or after age 65 years should receive only a single

dose.For most persons for whom PPSV23 is

indicated, the ACIP does not recommend routine revaccination. For

persons aged 19 to 64 years with functional or anatomic asplenia and for

persons with immunocompromising conditions, a second dose of PPSV23

should be given 5 years after the first dose. However, because of

uncertainty regarding clinical benefit and safety, the ACIP does not

recommend multiple revaccinations.

Other Indications for Administration

Underlying medical conditions or other indications for administration

of PPSV23 among adults aged 19 to 64 years include the following:

Immunocompetent persons with chronic heart

disease (excluding hypertension); chronic lung disease including chronic

obstructive pulmonary disease, emphysema, and asthma; diabetes

mellitus; cerebrospinal fluid leaks; cochlear implant; alcoholism;

chronic liver disease, including cirrhosis; and cigarette smoking;Persons with

functional or anatomic asplenia

(sickle cell disease and other hemoglobinopathies; congenital or

acquired asplenia, splenic dysfunction, or splenectomy);Immunocompromised

persons with congenital or

acquired immunodeficiencies (including B- [humoral] or T-lymphocyte

deficiency, complement deficiencies [particularly C1, C2, C3, and C4

deficiencies], and phagocytic disorders other than chronic granulomatous

disease); HIV infection; chronic renal failure; nephrotic syndrome;

leukemias; lymphomas; Hodgkin's disease; generalized malignancy;

diseases requiring treatment with immunosuppressive drugs, including

long-term systemic corticosteroids or radiation therapy; solid organ

transplantation; and multiple myeloma.

" Indirect vaccine effects (i.e., herd effects) have reduced

pneumococcal infections among unvaccinated persons of all ages,

including those aged ¡Ý65 years, since introduction of the routine infant

7-valent pneumococcal conjugate vaccine (PCV7) immunization program in

2000, " the guidelines authors write. " ...Despite the major direct and

indirect PCV7 effects, IPD remains an important cause of illness and

death. An estimated 43,500 cases and 5,000 deaths occurred among persons

of all ages in 2009; approximately 84% of IPD cases and nearly all

deaths occurred in adults. "

MMWR Morb Mortal Wkly Rep. 2010;59:1102-1106. Abstract

More information about pneumococcal disease in adults is available on the

National Foundation for Infectious Diseases website

Clinical Context

IPD is a major cause of death and illness in the United

States, with 5000 deaths and 43,500 cases in 2009. Immunization

recommendations from the ACIP have changed since the 1997

recommendations.

This is a report of the updated ACIP immunization guidelines for

adults, for the PPSV23 vaccine. Recommendations for children and infants

for the 13-valent pneumococcal conjugate vaccine and PPSV23 are

published separately.

http://cme.medscape.com/viewarticle/728245?src=cmemp & uac=117832MN

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