Pneus on pneumococcal vaccination from the ACIP

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The CDC Advisory Committee on Immunization Practices (ACIP) has just changed its recommendations for the use of pneumococcal vaccines for adults 19 years or older with immunocompromising conditions, such as functional or anatomic asplenia, CSF leaks, cochlear implants, HIV, some forms of cancer, and other conditions..

These immunocompromised patients should be given a dose of the new 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13), even if they have previously received the 23-valent pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax).  Immunocompromised patients previously immunized with PPSV23 should receive one dose of PCV13 if at least one year has passed. If not previously vaccinated, a single dose of PCV13 should be given first, followed by PPSV23 eight or more weeks later. This sequence optimizes titers elicited by the vaccines.

The new indication for double immunization is only for those adults who are immune compromised. Recommendations for other adults who have been advised to receive the PPSV23 have not changed. The table below should be helpful.

Indications for the administration of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults in the United States*
Risk group Underlying medical condition      PCV13    PPSV23
Recommended Recommended Revaccination with PPSV23 five years after first dose
Immunocompetent persons Chronic heart disease•              X  
Chronic lung diseaseΔ                   X  
Diabetes mellitus            X  
Cerebrospinal fluid leak              X          X  
Cochlear implant              X          X  
Alcoholism            X  
Chronic liver disease, cirrhosis            X  
Cigarette smoking            X  
Persons with functional or anatomic asplenia Sickle cell disease/other  hemaglobinopathy              X          X       X
Congenital or acquired asplenia              X          X       X
Immunocompromised persons Congenital or acquired immunodeficiency◊              X          X       X
Human immunodeficiency virus infection              X          X       X
Chronic renal failure              X          X       X
Nephrotic syndrome              X          X       X
Leukemia              X          X       X
Lymphoma              X          X       X
Hodgkin disease              X          X       X
Generalized malignancy              X          X       X
Iatrogenic immunosuppression§              X          X       X
Solid organ transplant              X          X       X
Multiple myeloma              X          X       X
* All adults aged ≥65 years should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine.
• Including congestive heart failure and cardiomyopathies, excluding hypertension.
Δ Including chronic obstructive pulmonary disease, emphysema, and asthma.
◊ Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease).
§ Diseases requiring treatment with immunosuppressive drugs, including long-term systemic glucocorticoids and radiation therapy.
Reproduced from: Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816.
 

S.pneumoniae remains a leading cause of serious illness among adults with an estimated 4,000 deaths yearly, primarily among adults. 

In response to this new recommendation PHC has expanded its coverage of immunizations to implement this change.

Marshall Kubota, MD

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