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ACIP workgroup recommends adult pneumococcal vaccination updates
A large number of data have become available since the original recommendations were created in 1997.
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ATLANTA – The Advisory Committee on Immunization Practices’ Pneumococcal Vaccines Workgroup identified key areas of adult pneumococcal polysaccharide vaccination recommendations in need of clarification and further reviewed current data available to update the original 1997 recommendations.
“We reviewed the duration of protection, safety, immunogenicity of the vaccine in adults and the optimal timing and frequency of vaccination. The evaluation process included a careful review of relevant data and when data were not available, expert opinions were solicited,” Julie Morita, MD, workgroup chair, said at the recent ACIP meeting.
Recommendations
Pekka Nuorti, MD, of the CDC, presented the workgroup’s considerations for the clarification and revision of the current PPV23 recommendations for the adult population.
“A lot of data have become available since the time the previous recommendations were created, and we have spent much of last year reviewing these data,” Nuorti said.
The workgroup examined Active Bacterial Core surveillance data, including a total population of 18.5 million people, to identify changes in the epidemiology of IPD in adults following vaccination with PCV7 during childhood.
Data were separated into three age groups: 18 to 49 years; 50 to 64 years; and 65 years and older.
“Following introduction of the vaccine, overall rates of invasive pneumococcal disease among all adult age groups declined by 16% to 38% for all serotypes,” Nuorti said. “When looking at only the seven serotypes in the conjugate vaccine, there have been dramatic decreases in the rates of invasive disease, ranging from 84% to 89%.”
Nuorti then presented the committee with various items to consider regarding revaccination with PPV23.
The workgroup suggests to further evaluate available data on the following factors:
- The safety of revaccination with PPV23.
- Potential benefits of revaccination.
- Immunological response to second dose of PPV23.
“Further research is needed to guide revaccination policy, specifically regarding clinical effectiveness, potential adverse immunological consequences of a repeat dose of PPV23, long-term persistence of antibodies and the best optimal sequence of PCV and PPV in adults when new adult vaccines become available,” Nuorti said.
Although the recommendation content was not changed, the recommendation notes, “All persons should be vaccinated with PPV23 at age 65 years. Those who received PPV23 prior to the age of 65 years should be administered another dose of the vaccine if at least five years have passed since their previous dose.” The workgoup proposed this clarification to the revacciantion recommendation language for people aged 64 and older.
“We anticipate having a formal proposal of recommendations completed by the end of 2008. Until then, there are a number of activities that will occur including a review of new data on pneumococcal polysaccharide vaccine revaccination and the review of new vaccines that are expected to be available in the near future,” Nuorti said. – by Jennifer Southall
For more information:
- Morita J. Pneumococcal Vaccines Workgroup: update.
- Nuorti P. Use of pneumococcal polysaccharide vaccine in adults.
- Both presented at: The Advisory Committee on Immunization Practices meeting; Atlanta; June 25-26, 2008.