Pneumococcal Polysaccharide Vaccine

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Contents 1 Indications 2 Contraindications 3 Dosage 4 Pharmacokinetics 5 Drug-interactions 6 Mechanism-of-action 7 Notes 8 More General Terms 9 Additional Terms 10 References

Indications

• primary immunization: immunity to pneumococcal lobar pneumonia & bacteremia in individuals >= 2 years of age who are at high risk of morbidity & mortality from pneumococcal infection

• all persons over 64 years of age
• persons aged 2-64 with chronic disease, especially:

• congestive heart failure
• pulmonary disease, including asthma & smoking [12]
• renal failure
• diabetes
• malignancy
• HIV infection

• hyposplenism

• splenectomy
• autosplenectomy, i.e. sickle cell disease

• asbestosis ( vaccination at diagnosis & 5 years later)

• revaccination

• consider if >= 6 years since initial vaccination

• asplenic patients who have received 14 valent pneumococcal vaccine

• recommended after 6 years in patients with nephrotic syndrome, renal failure or transplant patients
• recommended after 3-5 years in children with nephrotic syndrome, asplenia or sickle cell disease
• 3-4 months after completion of chemotherapy in patients with Hodgkin's disease who were vaccinated during chemotherapy
• a single revaccination is recommended in adults > 65 years of age >= 6 years since initial vaccination [7]
• revaccination 5 years after diagnosis & initial vaccination for asbestosis [3]

Contraindications

• active infections
• Hodgkin's disease (within 10 days of chemotherapy or radiation therapy)
• patients < 2 years of age
• pregnancy
• hypersensitivity to pneumococcal vaccine or any component

• Caution:

• use with caution in individuals who have had pneumococcal infection within the past 3 years
• may cause relapse in patients with stable idiopathic thrombocytopenic purpura ( ITP)
• have epinephrine available
• considered safe if patients on warfarin, if INR is therapeutic [4]
  

• pregnancy-category C
• safety in lactation ?

Dosage

• Adults & children >= 2 years of age: 0.5 mL IM or SC

• Injection:

• 25 ug each of 23 polysaccharide isolates
• 0.5 mL/dose (2.5 mL vials)

Pharmacokinetics

• protective effects seen by the 3rd week after vaccination
• antibody levels remain elevated for at least 5 years after vaccination
• elimination: liver Adverse reactions:

• common (> 10%)

• induration & soreness at the injection site (2-3 days)

• ucommon (< 1%)

• paresthesias, Guillain-Barre syndrome, low-grade fever, erythema, rash, myalgia, arthralgia, anaphylaxis

• other - headache, photophobia

Drug-interactions

• decreased effect with immunosuppressive agents, immune globulin, & other live virus vaccines within 1 month*

• * patients with lupus erythematosus or rheumatoid arthritis treated with immunosuppressive agents respond variably to the pneumococcal vaccine [5]

Mechanism-of-action

• primary immunization with 23 polysaccharide isolates
• reduces macrolide-resistant pneumococcal infections [6]
• reduces mortality of hospitalized elderly [8]
• reduces pneumococcal bacteremia, but not noninvasive pneumococcal pneumonia or bronchitis [9,11]

Notes

• introduced in 1983

More General Terms

• vaccine

Additional Terms

• pneumococcal congugate vaccine (Prevnar, Prevnar 13, PCV7)
• Streptococcus pneumoniae (pneumococcus)

References

1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
4. Prescriber's Letter 9(1):5 2002
5. Journal Watch 22(4):30, 2002 Elkayam O et al Immunogenicity and safety of pneumococcal vaccination in patients with rheumatoid arthritis or systemic lupus erythematosus. Infect Dis 34:147, 2002 PMID: [1]
6. Journal Watch 25(9):70, 2005 Stephens DS, Zughaier SM, Whitney CG, Baughman WS, Barker L, Gay K, Jackson D, Orenstein WA, Arnold K, Schuchat A, Farley MM; Georgia Emerging Infections Program. Incidence of macrolide resistance in Streptococcus pneumoniae after introduction of the pneumococcal conjugate vaccine: population-based assessment. Lancet. 2005 Mar 2;365(9462):855-63. PMID: [2]
7. Centers for Disease Control and Prevention (CDC) Recommended adult immunization schedule, United States 2002-2003 MMWR Morb Mortal Wkly Rep 2002; 51:904 PMID: [3]
8. Fisman DN et al, Prior pneumococcal vaccination is associated with reduced death complications and length of stay among hospitalized adults with community-acquired pneumonia. Clin Infect Dis 2006; 42:1093 PMID: [4]
9. Musher DM et al, Effect of pneumococcal vaccination: A comparison of vaccination rates in patients with bacteremic and nonbacteremic pneumococcal pneumonia. Clin Infest Dis 2006, 43:1004 PMID: [5]
10. Prescriber's Letter 14(5): 2007 Revaccination With Pneumococcal Vaccine: Who Needs It? Detail-Document#: [6] (subscription needed) [7]
11. Huss A et al Efficacy of pneumococcal vaccination in adults: A meta-analysis. CMAJ 2009 Jan 6; 180:48. PMID: [8]
    - Andrews R and Moberley SA. The controversy over the efficacy of pneumococcal vaccine. CMAJ 2009 Jan 6; 180:18. PMID: [9]
12. Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009. Ann Intern Med 2009 Jan 6; 150:40. PMID: [10]
    - Poland GA and Schaffner W. Immunization guidelines for adult patients: An annual update and a challenge. Ann Intern Med 2009 Jan 6; 150:53. PMID: [11]
13. Nuorti JP for the Centers for Disease Control and Prevention Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Morbidity and Mortality Weekly Report (MMWR) September 3, 2010 / 59(34);1102-1106 [12]
14. Centers for Disease Control and Prevention (CDC) Recommended adult immunization schedule - United States 2012 MMWR Morb Mortal Wkly Rep 2012 / 61(04);1-7 [13]
15. National Guideline Clearinghouse Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Centers for Disease Control and Prevention (CDC) ngc-guideline: [14]

pneumococcal polysaccharide vaccine, polyvalent (PneumoVax 23, Pnu-Immune 23)