Pneumococcal Vaccine

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

1. See Also
   1. Pneumococcal Conjugate Vaccine
2. Pharmacokinetics
   1. Purified capsular PolysaccharideAntigens from 23 serotypes
   2. These serotypes are responsible for 88% of invasive pneumococcal disease
3. Indications: Adult Pneumococcal Vaccine Indications In General
   1. Age 65 years and older
   2. Nephrotic Syndrome or Chronic Renal Failure
   3. Heart Disease (e.g. Congestive Heart Failure, Cardiomyopathy)
   4. Liver disease
   5. Lung Disease (e.g. Asthma, COPD)
   6. Alcoholism
   7. Diabetes Mellitus
   8. Tobacco users (over age 50 years)
   9. Immunodeficiency (congenital or acquired)
      1. Generalized Malignancy
      2. Leukemia or Lymphoma
      3. Solid Organ Transplant
      4. Immunosuppression (e.g. Chemotherapy, transplant, longterm ImmunosuppressionCorticosteroids)
      5. Human Immunodeficiency Virus
      6. Sickle Cell Disease or other Hemoglobinopathy
      7. Functional or anatomic Asplenia
         1. Administer 2 weeks prior to splenectomy
   10. Anatomic abnormalities
       1. Cerebrospinal Fluid Leak
       2. Cochlear Implant
   11. High risk environments
       1. Native American Reservations
       2. Nursing Homes
4. Indications: Children (age 2 years and older, in addition to Prevnar that is given in Primary Series)
   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. Dosing regimens are being modified in 2022 by CDC
      1. Prevnar 20 is sufficient alone, and does not require Pneumovax
      2. GIve Prevnar 20 alone (or Vaxneuvance AND Pneumovax 23)
   2. See Prevnar for dosing Pneumococcal Vaccine schedules
   3. Pneumovax 23 Indications (when Vaxneuvance or Prevnar 13 are used)
      1. One dose of Pneumovax 23 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)
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
   2. Kobayashi (2022) MMWR Morb Mortal Wkly Rep 71(4): 109-17 [PubMed]