Pneumococcal Vaccine

Aka: Pneumococcal Vaccine, Polyvalent pneumococcal Vaccine, Pneumovax 23, Pneumovax, Pnu-Imune 23

1. See Also
   1. Pneumococcal Conjugate Vaccine
2. Pharmacokinetics
   1. Purified capsular polysaccharide antigens from 23 serotypes
   2. These serotypes are responsible for 88% of invasive pneumococcal disease
3. Indications: Adult Vaccine
   1. Age 65 years and older
   2. Sickle Cell Disease
   3. Functional or anatomic Asplenia
      1. Administer 2 weeks prior to splenectomy
   4. Nephrotic Syndrome or Chronic Renal Failure
   5. Immunosuppression
   6. Human Immunodeficiency Virus
   7. Heart, lung or liver disease
   8. Asthma
   9. Tobacco users (starting at age 50 years)
   10. High risk environments
       1. Native American Reservations
       2. Nursing Homes
4. Indications: Children (age 2 years and older)
   1. Chronic illness (including Corticosteroid dependent Asthma)
   2. Functional Asplenia or anatomic Asplenia
   3. Immunocompromised state
   4. Renal disease (e.g. Nephrotic Syndrome, Renal Failure)
5. Dosing
   1. One dose is sufficient for most patients at age 65 years
   2. Indication for single dose ages 2 to 64 years
      1. See Indications above
      2. Give a second dose at age 65 or at least 5 years after the last dose
   3. Indication for 2 doses at more than 5 years apart at ages 2 to 64 years
      1. Give third dose at age 65 years or at least 5 years after the last dose
      2. Chronic renal disease (Renal Failure, Nephrotic Syndrome)
      3. Asplenia
      4. Sickle Cell Anemia
      5. Immunocompromised state
         1. HIV Infection
         2. Leukemia
         3. Lymphoma
         4. Multiple Myeloma
         5. Iatrogenic (e.g. organ transplant, Radiation Therapy, Chemotherapy)
   4. Timing with Prevnar 13 (recommended as of 2012 for immunocompromised adults)
      1. CDC modified Prevnar 13 recommendations for healthy seniors in 2019
         1. Pneumovax 23 alone (without Prevnar 13) is sufficient in healthy seniors
         2. NNT 2600 Prevnar 13 vaccinated healthy seniors to prevent one case of Pneumonia
         3. Prevnar 13Vaccine in children as Primary Series has protected seniors via herd immunity
         4. (2019) Presc Lett 26(9): 49
      2. No prior Pneumovax or immunocompromised state
         1. Give Pneumovax 23 at least 8 weeks after Prevnar 13
      3. Prior Pneumovax
         1. Give Prevnar 13 at least one year after Pneumovax 23
   5. Schedule for those over age 65 years
      1. No prior Pneumovax 23
         1. Prevnar 13 after age 65 year birthday AND
         2. Pneumovax 23 at 6-12 months after Prevnar 13 dose (8 weeks if immunocompromised)
      2. Prior Pneumovax 23 after age 65 year birthday
         1. Prevnar 13 after age 65 year birthday
         2. No further Pneumovax 23 needed
      3. Prior Pneumovax 23 before age 65 year birthday
         1. Prevnar 13 after age 65 year birthday AND at least one year after Pneumovax 23 AND
         2. Pneumovax 23 at 12 months after Prevnar 13 dose AND 5 years after last Pneumovax 23
      4. References
         1. (2014) Presc Lett 21(11): 63-64
6. Precautions
   1. Administer to high risk women before pregnancy
   2. ACIP recommends avoiding in pregnancy
   3. Pneumococcal Vaccine may be given on same day as other Vaccines (e.g. Influenza Vaccine, Shingles Vaccine)
      1. PrevnarVaccine may have reduced Antibody response when given with Influenza Vaccine
      2. However, given both Vaccines (Prevnar and Influenza) does not reduce their efficacy
7. References
   1. Presc Lett 22(11): 63