Study Explores Optimal Pneumococcal Vaccine Strategies in Pediatric Patients With Asthma

Invasive pneumococcal disease (IPD) and pneumonia constitute leading causes of morbidity and mortality throughout the world. Asthma is one of the most common chronic diseases in childhood. Pneumococcal conjugate vaccines (PCVs) have transformed prevention efforts in children, allowing for a drastic reduction in cases of IPD. However, despite PCV vaccination, children with asthma continue to harbor a heightened risk of IPD compared with their nonasthmatic counterparts.^1,2

Research has demonstrated that asthma is an independent risk factor for invasive pneumococcal disease. One study investigated hundreds of individuals and found that persons with asthma had almost double the risk of IPD (adjusted odds ratio, 2.4; 95% CI, 1.9–3.1) compared with controls. Although there is a clear increased risk of IPD in children with asthma, optimal vaccination strategies remain unclear; guidelines for the management of asthma do not include pneumococcal vaccination as a strategy to prevent infectious complications, and recommendations for pneumococcal vaccination make no specific mention of patients with asthma.^1,2

Specifically, the effectiveness of immunization in children with asthma—including the use of booster doses—is undetermined. The current authors, who published their results in the Journal of Asthma, sought to assess serological responses and clinical outcomes following a pneumococcal booster vaccination in pediatric patients with asthma. They conducted a retrospective chart review on 64 patients with asthma aged 2 through 17 years who previously received at least 1 pneumococcal booster dose.³

Data on a series of key factors were collected, including demographics, asthma severity, steroid use, and vaccine titers. Serotype-specific titer thresholds assisted in defining immune protection, while chi-squared tests were employed to determine changes in asthma classification and systemic steroid use pre- and postvaccination.³

At 4 to 8 weeks following vaccination, 96.9% of the population demonstrated protective antibody titers. Despite this widespread protection early on, over 70% of those retested over 6 months later lost protective titers, suggesting that immunity from a booster vaccination can wane in patients with asthma and that subsequent booster doses could be an effective intervention for disease prevention.³

The investigators observed statistically significant reductions in asthma severity (P < .001) and systemic steroid use (P < .001) following vaccination, demonstrating the positive indirect benefits of pneumococcal vaccination in patients with asthma. In one notable development, 100% of patients reporting severe asthma and 46% reporting moderate asthma improved in their classification. Furthermore, most patients who previously required frequent steroids to treat their asthma prior to vaccination showed reduced need following vaccination.³

“Pneumococcal booster vaccination elicited a strong initial immune response and was associated with improved asthma outcomes,” the study authors wrote in their conclusion. “However, waning immunity highlights the need for further research into optimal vaccine scheduling, booster timing, and the influence of immune-modulating therapies in this high-risk pediatric population.”³

Pharmacists can act as vaccine counselors and facilitators for patients with asthma, who likely encounter their pharmacists on a consistent basis when inquiring about their condition or seeking medication refills. Pharmacists should inform patients on the direct and indirect benefits of pneumococcal vaccination, including significantly reducing their risk of IPD and severe respiratory outcomes. Additionally, beyond the debilitating effects of IPD alone, the disease can exacerbate and worsen asthma outcomes. Patients should be given ample opportunities for questions regarding pneumococcal vaccination and can work with a pharmacist on the optimal timing and frequency of pneumococcal booster doses.

REFERENCES

1. Castro-Rodriguez JA, Abarca K, Forno E. Asthma and the risk of invasive pneumococcal disease: A meta-analysis. Pediatrics. 2020;145(1)Le20191200. doi:10.1542/peds.2019-1200

2. Talbot TR, Hartert TV, Mitchel E, et al. Asthma as a risk factor for invasive pneumococcal disease. N Engl J Med. 2005;352(20):2082-2090. doi:10.1056/NEJMoa044113

3. Brawley R, Rey AE, Nazario AN. Enhancing pneumococcal vaccine efficacy in pediatric patients with asthma: Investigating immune response modulation. Journ of Asthma. 2025:1–8. doi:10.1080/02770903.2025.2603328