PNEUMOVAX 23 is indicated for vaccination against pneumococcal disease caused by those pneumococcal types included in the vaccine. Effectiveness of the vaccine in the prevention of pneumococcal pneumonia and pneumococcal bacteremia has been demonstrated in controlled trials in South Africa and France and in case-controlled studies.
PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine.
If it is known that a person has not received any pneumococcal vaccine or if earlier pneumococcal vaccination status is unknown, then persons in the categories listed as follows should be administered pneumococcal vaccine; however, if a person has received a primary dose of pneumococcal vaccine, before administering an additional dose of vaccine, please refer to the Revaccination section as follows.
Vaccination with PNEUMOVAX 23 is recommended for selected individuals as follows: Immunocompetent persons: routine vaccination for persons 50 years of age or older; persons aged ≥2 years with chronic cardiovascular disease (including congestive heart failure and cardiomyopathies), chronic pulmonary disease (including chronic obstructive pulmonary disease and emphysema), or diabetes mellitus; persons aged ≥2 years with alcoholism, chronic liver disease (including cirrhosis) or cerebrospinal fluid leaks; persons aged ≥2 years with functional or anatomic asplenia (including sickle cell disease and splenectomy); persons aged ≥2 years living in special environments or social settings (including Alaskan Natives and certain American Indian populations).
Immunocompromised persons: persons aged ≥2 years, including those with HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, chronic renal failure or nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant (for selected groups, see Timing of Vaccination as follows).
PNEUMOVAX 23 may not be effective in preventing infection resulting from basilar skull fracture or from external communication with cerebrospinal fluid.
Timing of Vaccination: Pneumococcal vaccine should be given at least two weeks before elective splenectomy, if possible. For planning cancer chemotherapy or other immunosuppressive therapy (e.g., for patients with Hodgkin's disease or those who undergo organ or bone marrow transplantation), the interval between vaccination and initiation of immunosuppressive therapy should be at least two weeks. Vaccination during chemotherapy or radiation therapy should be avoided. Pneumococcal vaccine may be given several months following completion of chemotherapy or radiation therapy for neoplastic disease. In Hodgkin's disease, immune response to vaccination may be suboptimal for two years or longer after intensive chemotherapy (with or without radiation). For some patients, during the two years following the completion of chemotherapy or other immunosuppressive therapy (with or without radiation), significant improvement in antibody response has been observed, particularly as the interval between the end of treatment and pneumococcal vaccination increased.
Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis is confirmed.
Use With Other Vaccines: It is recommended that pneumococcal vaccine may be administered at the same time as influenza vaccine (by separate injection in the other arm) without an increase in side effects or decreased antibody response to either vaccine†. In contrast to pneumococcal vaccine, influenza vaccine is recommended annually, for appropriate populations.
PNEUMOVAX 23 and ZOSTAVAX* should not be given concurrently because concomitant use in a clinical trial resulted in reduced immunogenicity of ZOSTAVAX. In this trial, the immunogenicity of PNEUMOVAX 23 was not affected by ZOSTAVAX. Consider administration of the two vaccines separated by at least 4 weeks.
Revaccination: Revaccination of immunocompetent persons previously vaccinated with 23-valent polysaccharide vaccine is not routinely recommended.
However, revaccination once is recommended for persons ≥2 years of age who are at highest risk of serious pneumococcal infection and those likely to have a rapid decline in pneumococcal antibody levels, provided that at least five years have passed since receipt of a first dose of pneumococcal vaccine.
The highest risk group includes persons with functional or anatomic asplenia (e.g., sickle cell disease or splenectomy), HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome, or other conditions associated with immunosuppression (e.g., organ or bone marrow transplantation), and those receiving immunosuppressive chemotherapy (including long-term systemic corticosteroids) (See previously mentioned Timing of Vaccination).
For children ≤10 years of age at revaccination and at highest risk of severe pneumococcal infection (e.g., children with functional or anatomic asplenia, including sickle cell disease or splenectomy or conditions associated with rapid antibody decline after initial vaccination including nephrotic syndrome, renal failure or renal transplantation), it is recommended that revaccination may be considered three years after the previous dose†.
If prior vaccination status is unknown for patients in the high risk group, patients should be given pneumococcal vaccine.
All persons ≥65 years of age who have not received vaccine within 5 years (and were <65 years of age at the time of vaccination) should receive another dose of vaccine.
Because data are insufficient concerning the safety of pneumococcal vaccine when administered three or more times, revaccination following a second dose is not routinely recommended.
†The Advisory Committee on Immunization Practices (ACIP).