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CDC Advisory Panel Votes to Update Pneumococcal Vaccination Recommendations
The ACIP also voted to recommend that people aged 19 through 64 years who smoke cigarettes should receive PPSV23 as well as smoking-cessation counseling. This recommendation is the first time the ACIP has recommended a vaccine specifically for people who smoke. The ACIP stated that people at increased risk for invasive pneumococcal disease include those who smoke cigarettes. This recommendation is based on data that showed smokers are approximately four times more at risk for pneumococcal disease than non-smokers. Data also showed that smoking was significantly associated with invasive pneumococcal disease, which includes potentially serious infections, such as meningitis or bacteremia. The current physician prescribing information for PNEUMOVAX 23 does not include data on the use of the vaccine in people who smoke cigarettes, nor does it include cigarette smokers among those who should be vaccinated. However, the ACIP has noted that many people who smoke cigarettes may have another condition for which PNEUMOVAX 23 is currently recommended. ACIP has previously recommended the use of PPSV23 in all adults 65 years of age and older, and for certain individuals ages 2 years and older at increased risk for developing pneumococcal infection or experiencing severe disease and complications because of chronic illness or underlying medical conditions.
PNEUMOVAX 23 is indicated for vaccination against pneumococcal disease caused by those pneumococcal types included in the vaccine. PNEUMOVAX 23 is contraindicated in individuals who are hypersensitive to any component of the vaccine. PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine.
The ACIP also voted to revise the recommendations for use of PPSV23 in Alaskan Native and American Indian children and adults and to clarify the recommendations for revaccination of high-risk children. For these children, the ACIP voted to recommend that routine use of PPSV23 after administration of PCV7 (pneumococcal conjugate vaccine) is not recommended for Alaskan Native or American Indian children aged 24 through 59 months. However, in special situations, public-health authorities may consider recommending PPSV23 after PCV7 for Alaskan Native or American Indian children aged 24 through 59 months who are living in areas in which risk of invasive pneumococcal disease is increased. For adults, ACIP stated that routine use of PPSV23 is not recommended for Alaskan Native or American Indian people younger than 65 years old unless they have underlying medical conditions that are PPSV23 indications. However, public health authorities may consider recommending PPSV23 for Alaskan Natives and American Indians aged 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.
Regarding revaccination of high-risk children, the ACIP stated that a second dose of PPSV23 is recommended five years after the first dose of PPSV23 for people ages 2 and older who are immunocompromised, have sickle-cell disease, or functional or anatomic asplenia.
Details of these ACIP provisional recommendations for pneumococcal vaccination will be made available from the CDC. These provisional recommendations are under review by the director of the CDC and the Department of Health and Human Services and will become official when published in CDC’s Morbidity and Mortality Weekly Report (MMWR).
About PNEUMOVAX 23
PNEUMOVAX 23 is the only pneumococcal vaccine approved in the U.S. for use in adults. According to the prescribing information for PNEUMOVAX 23, the vaccine is recommended for routine vaccination of people 50 years of age or older, and select other individuals ages 2 years and older with certain risk factors. Specifically, PNEUMOVAX 23 is recommended for immuno-competent individuals ages 2 years and older with chronic cardiovascular disease (including congestive heart failure and cardiomyopathies), chronic pulmonary disease (including chronic obstructive pulmonary disease and emphysema), diabetes mellitus, those with alcoholism, chronic liver disease (including cirrhosis) or cerebrospinal fluid leaks, and with functional or anatomic asplenia (including sickle cell disease and splenectomy).
PNEUMOVAX 23 is also recommended per the prescribing information for people ages 2 years and older who live in special environments or social settings (including Alaskan Natives and American Indian populations). Certain immunocompromised people ages 2 and older are also recommended for PNEUMOVAX 23 -- those with HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy, chronic renal failure or nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant. Vaccination with PNEUMOVAX 23 may not offer 100 percent protection from pneumococcal infection. PNEUMOVAX 23 is administered as a single dose subcutaneously or intramuscularly (preferably in the deltoid muscle or lateral mid-thigh).
The ACIP states that PNEUMOVAX 23 may be administered at the same time as the influenza vaccine (by separate injection in the other arm) without an increase in side effects or decreased antibody response to either vaccine. In contrast to influenza vaccine, pneumococcal vaccine is not recommended annually.
Source: Merck & Co.