pneumococcal polysaccharide vaccine, polyvalent (PneumoVax 23, Pnu-Immune 23, PPSV-23)
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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:
- chronic cardiovascular disease, including hypertension
- pulmonary disease, including COPD, asthma & smoking[12]
- renal failure including nephrotic syndrome
- diabetes mellitus
- malignancy
- HIV infection
- chronic liver disease (including cirrhosis)
- alcoholism
- CSF leak
- cohlear implant
- immunosuppression or immunodeficiency
- hyposplenism
- 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]
- consider if >= 6 years since initial vaccination
* antibody levels remain at levels considered protective beyond 5 years in patients with autoimmune rheumatic disease[18]
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]
- considered safe in hospitalized patients with mild to moderate illness[3]
Benefit/risk
- number needed to treat to prevent one case of invasive pneumococal pneumonia = 3,333 (range: 1429-12,500)[15]
- NNT to prevent one case of pneumococal pneumonia = 38[16]
Dosage
- adults & children >= 2 years of age: 0.5 mL IM or SC
- adults who have not previously received either vaccine should be given one dose of Prevnar followed by one dose of Pneumovax > 1 year later (CDC)[17]
- CDC's Advisory Committee on Immunization Practices (ACIP) recommends
- for all adults >= 65 years [19
- Prevnar-13 prior to this recommended for at risk seniors
- immunosuppression, CSF leak, or cochlear implant[19]
- long-term care residemts[19]
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 effects
- 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
Additional terms
- pneumococcal congugate vaccine (Prevnar, Prevnar 13, PCV13, Prevnar-20, PCV20, Prevnar-15, PCV15, Vaxneuvance, Capvaxive, PCV21, PHiD-CV10, PCV10, Synflorix)
- Streptococcus pneumoniae (pneumococcus)
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Jump up to: 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 18. American College of Physicians, Philadelphia 1998, 2006, 2012, 2018.
- ↑ Jump up to: 4.0 4.1 Prescriber's Letter 9(1):5 2002
- ↑ Jump up to: 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/11740700
- ↑ Jump up to: 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15752529
- ↑ Jump up to: 7.0 7.1 Centers for Disease Control and Prevention (CDC) Recommended adult immunization schedule, United States 2002-2003 MMWR Morb Mortal Wkly Rep 2002; 51:904 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12418546
- ↑ Jump up to: 8.0 8.1 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: https://www.ncbi.nlm.nih.gov/pubmed/16575726
- ↑ Jump up to: 9.0 9.1 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: https://www.ncbi.nlm.nih.gov/pubmed/16983612
- ↑ Prescriber's Letter 14(5): 2007 Revaccination With Pneumococcal Vaccine: Who Needs It? Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230508&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jump up to: 11.0 11.1 Huss A et al Efficacy of pneumococcal vaccination in adults: A meta-analysis. CMAJ 2009 Jan 6; 180:48. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19124790
Andrews R and Moberley SA. The controversy over the efficacy of pneumococcal vaccine. CMAJ 2009 Jan 6; 180:18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19124781 - ↑ Jump up to: 12.0 12.1 Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009. Ann Intern Med 2009 Jan 6; 150:40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19124819
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: https://www.ncbi.nlm.nih.gov/pubmed/19124821 - ↑ 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 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm corresponding NGC guideline withdrawn Jan 2016
- ↑ Centers for Disease Control and Prevention (CDC) Recommended adult immunization schedule - United States 2012 MMWR Morb Mortal Wkly Rep 2012 / 61(04);1-7 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a9.htm
- ↑ Jump up to: 15.0 15.1 Kelly H1, Attia J, Andrews R, Heller RF. The number needed to vaccinate (NNV) and population extensions of the NNV: comparison of influenza and pneumococcal vaccine programmes for people aged 65 years and over. Vaccine. 2004 Jun 2;22(17-18):2192-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15149776
- ↑ Jump up to: 16.0 16.1 Moore RA et al Are the pneumococcal polysaccharide vaccines effective? Meta-analysis of the prospective trials. BMC Family Practice 2000, 1:1-1 http://www.biomedcentral.com/1471-2296/1/1
- ↑ Jump up to: 17.0 17.1 Kobayashi M et al Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Weekly. September 4, 2015 / 64(34);944-947 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm
- ↑ Jump up to: 18.0 18.1 Broyde A et al. Longterm efficacy of an antipneumococcal polysaccharide vaccine among patients with autoimmune inflammatory rheumatic diseases. J Rheumatol 2016 Feb; 43:267. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26773117 <Internet> http://www.jrheum.org/content/43/2/267
- ↑ Jump up to: 19.0 19.1 19.2 19.3 19.4 19.5 Melville NA CDC Issues New Pneumococcal Vaccine Recommendations for Adults. Medscape. Feb 1, 2022
Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109-117 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35085226 Free article https://www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm
Centers for Disease Control and Prevention. Pneumococcal vaccination: Information for healthcare professionals. CDC 2022 Jan 24 https://www.cdc.gov/vaccines/vpd/pneumo/hcp/index.html