pneumococcal polysaccharide vaccine, polyvalent (PneumoVax 23, Pnu-Immune 23, PPSV-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
- ↑ 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.
- ↑ 4.0 4.1 Prescriber's Letter 9(1):5 2002
- ↑ 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://pubmed.ncbi.nlm.nih.gov/11740700
- ↑ 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://pubmed.ncbi.nlm.nih.gov/15752529
- ↑ 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://pubmed.ncbi.nlm.nih.gov/12418546
- ↑ 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://pubmed.ncbi.nlm.nih.gov/16575726
- ↑ 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://pubmed.ncbi.nlm.nih.gov/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
- ↑ 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://pubmed.ncbi.nlm.nih.gov/19124790
Andrews R and Moberley SA. The controversy over the efficacy of pneumococcal vaccine. CMAJ 2009 Jan 6; 180:18. PMID: https://pubmed.ncbi.nlm.nih.gov/19124781 - ↑ 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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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
- ↑ 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://pubmed.ncbi.nlm.nih.gov/15149776
- ↑ 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
- ↑ 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
- ↑ 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://pubmed.ncbi.nlm.nih.gov/26773117 <Internet> http://www.jrheum.org/content/43/2/267
- ↑ 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://pubmed.ncbi.nlm.nih.gov/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 - ↑ McPherron A Focus on Invasive Pneumococcal Disease Prevention in Adults. This study assessed the effectiveness of of PPV23 for pneumococcal disease in older adults. Here are the findings. Medpage Today. 2026. Feb 8. https://www.medpagetoday.com/resource-centers/focus-inv-pneumo-disease-adults/ppv23-older-adults/6212
Niessen FA, Steens A, Knol MJ et al Impact and vaccine effectiveness of the 23-valent pneumococcal polysaccharide vaccine in adults aged 65 years or older in the Netherlands. Clin Microbiol Infect. 2025 Nov 12:S1198-743X(25)00553-1. PMID: https://pubmed.ncbi.nlm.nih.gov/41237898