CDC Committee: High-Risk Adults Should Get 2 Pneumococcal Vaccines

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Friday, July 27, 2012
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Immunocompromised adults should receive the Prevnar 13 vaccine in addition to the Pneumovax 23 vaccine, the Advisory Committee on Immunization Practices has recommended.

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended that immunocompromised adults receive a second pneumococcal vaccine. The recommendation for immunization with the 13-valent pneumococcal conjugate vaccine (Prevnar 13, PCV13) in addition to the 23-serotype polysaccharide vaccine (Pneumovax 23, PPSV23) was made at the ACIP’s meeting on June 20, 2012, in Atlanta.
 
The ACIP based its decision on evidence that the additional vaccine confers broader protection against pneumonia and invasive pneumococcal disease (IPD) and that its benefits will most likely outweigh any harm to patients with compromised immune systems, who are at elevated risk of invasive disease.
 
The new recommendation includes patients with cochlear implants or cerebrospinal fluid leaks in the immunocompromised category. Traditionally included in this category have been patients who have had organ transplants and those with functional or anatomic asplenia, congenital or acquired immunodeficiencies, HIV infection, chronic renal failure or nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, diseases requiring treatment with immunosuppressive drugs (including long-term systemic corticosteroids or radiation therapy), and multiple myeloma.
 
The CDC is expected to incorporate the new PCV13 recommendations into the current PPSV23 guidance, which recommends PPSV23 for all individuals aged 65 and older and for those aged 2 to 64 who are at risk of pneumococcal infection due to chronic illness or underlying medical conditions, including immunocompromised patients. The CDC recommends a second dose no sooner than 5 years after the first dose for adults aged 19 to 64 with functional or anatomic asplenia or immunocompromising conditions. The FDA has approved PCV13 for patients aged 6 months through 5 years to prevent IPD and in those aged 50 and older to prevent pneumonia and IPD.
 
The ACIP’s specific recommendations are as follows: Adults aged 19 and older with immunocompromising conditions who have not previously received PCV13 or PPSV23 should receive a single dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later. Adults aged 19 and older with immunocompromising conditions who have previously received at least one dose of PPSV23 should receive a single dose of PCV13 no sooner than 1 year after the last PPSV23 dose. If patients require another PPSV23 dose, it should be administered no sooner than 8 weeks after PCV13 and 5 years after the last PPSV23 dose.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

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