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ACIP updates recommendations for prevention of invasive pneumococcal vaccine among adults
Nuorti JP. MMWR. 2010;59:1102-1106.
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The Advisory Committee on Immunization Practices has updated recommendations for the use of the 23-valent pneumococcal polysaccharide vaccine for the prevention of invasive pneumococcal disease among all adults.
A statement published in the Morbidity and Mortality Weekly Report contains the following updates:
- 23-valent pneumococcal polysaccharide vaccine (PPSV23) should be administered to adults aged 19 to 64 years with chronic or immunosuppressing medical conditions, including those who have asthma.
- Adults aged 19 to 64 years who smoke cigarettes should receive PPSV23 and smoking cessation guidance.
- Routine PPSV23 use is no longer recommended for Alaska Natives or American Indians aged younger than 65 years, unless they have medical indications for PPSV23. However, in certain situations, public health authorities may recommend PPSV23 for Alaska Natives and American Indians aged 50 to 64 years who are living in areas where the risk for invasive pneumococcal disease is increased.
- Everyone should be vaccinated with PPSV23 at age 65 years. Those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose. Those who receive PPSV23 at or after age 65 years should receive only a single dose.
- ACIP does not recommend routine revaccination for those for whom PPSV23 is indicated. A second dose of PPSV23 is recommended 5 years after the first dose for people aged 19 to 64 years with functional or anatomic asplenia and for those with immunocompromising conditions. ACIP does not recommend multiple revaccinations because of uncertainty regarding clinical benefit and safety.
Invasive pneumococcal diseases (IPD) are defined as bacteremia, meningitis or infection of other normally sterile sites.
The updated recommendations account for increased risk for IPD among individuals with congenital or acquired immunodeficiency, abnormal innate immune response, HIV or functional or anatomic asplenia, including sickle cell disease or congenital or surgical asplenia, according to ACIP officials. Higher rates of IPD have also been observed among Alaska Native and other Native American children; in adults from those demographic populations, IPD is more likely to occur in individuals who smoke or use alcohol heavily.
Between 1998-1999 and 2006-2007, among individuals aged 18 to 64 years, the proportion of individuals with underlying medical conditions who developed IPD increased from 52% to 59%; during that same time period, among individuals at least 65 years old, the increase was from 69% to 81%.
“This trend suggests that adults with high-risk conditions might not have benefited as much from the indirect protective effects of childhood PCV7 immunization as persons who are relatively healthy,” the authors wrote.
A growing body of evidence indicates that individuals with asthma may be at increased risk for IPD. However, ACIP officials said further research is needed because of the difficulty in distinguishing between asthma and chronic obstructive pulmonary disease, particularly in elderly populations.
Results of a recent population-based, case-control study indicated that cigarette smokers aged 18 to 64 years were more than four times more likely than non-smokers to acquire IPD (OR=4.1; 95% CI, 2.4-7.3), according to a CDC report. Other results indicated links between increased risk for IPD and number of cigarettes smoked, pack-years of smoking and among immunocompromised smokers.