Streptococcus pneumoniae CDC
Pneumococcal Disease Infection caused by the bacteria, Streptococcus pneumoniae» otitis media 20 million office visits (28-55% Strep)» pneumonia 175,000 cases annually» meningitis Leading cause 3000-6000 cases annually» bacteremia 50,000 cases annually
MMWR 2000
Invasive Pneumococcal Disease Nearly 100 serotypes of Streptococcus pneumoniae Ten serotypes cause 62% of disease worldwide Seven serotypes cause 80% of disease in children <6 years Serotypes vary by age and geographic location
Pneumococcal Vaccines Two vaccine preparations Pneumococcal conjugate 13 valent (PCV13) Pneumococcal polysaccharide 23 valent (PPSV23)
Pneumococcal Conjugate Vaccine (PCV13)
PCV13 13-valent vaccine preparation conjugated to diphtheria carrier protein Expands coverage, including serotypes that have emerged since widespread use of PCV7
PCV13 Indications Universal immunization for children <23 months of age 2,4,6 and 12-15 month schedule can be administered concurrently with other childhood vaccines catch up schedule available for children up to age 71 months with incomplete PCV7 or complete PCV7 series Single dose for children aged 6-18 years Asplenia, sickle cell, HIV, immunocompromising condition, cochlear implants, CSF leaks
MMWR 2005
PCV13 Recommendations Licensed for adults >50 years Recommended for immunosuppressed >6 years and those >65 years
PCV13 for Immunosuppressed Recommended for immunosuppressed >6 years Functional or anatomic asplenia Immunocompromising conditions Congenital or acquired immunodeficiency HIV infection Chronic renal failure or nephrotic syndrome Malignancies (leukemia, lymphoma, generalized, multiple myeloma) Diseases requiring immunosuppressive therapy, including steroids Solid organ transplant Cerebral spinal fluid leaks or cochlear implants
PCV13 for the Elderly Recommended for all those 65 years of age and older who did not receive before
Pneumococcal Polysaccharide Vaccine (PPV23) Vaccine composition capsular polysaccharide inducing type-specific antibodies 23 valent vaccine 23 serotypes covering 85-90% of bacteremic infections
Current PPSV23 Indications Adults with chronic illness Cardiovascular or pulmonary disease including asthma Diabetes Alcoholism Smokers Adults over 65 years of age
PPSV23 Indications Immunocompromised adults Splenic dysfunction or asplenia Lymphoma, multiple myeloma Chronic renal failure, nephrotic syndrome Other conditions associated with immunosuppression Adults with asymptomatic or symptomatic HIV infection Individuals with cochlear implants
PPSV23 for Patients with Asthma Risk of invasive disease 2-6 times higher than controls Risk increases with asthma severity Majority of disease caused by vaccine serotypes Single dose of pneumococcal polysaccharide vaccine for all patients with asthma aged 19-64 years
PPSV23 for Smokers Four fold increase risk in invasive disease Risk correlates with number of cigarettes smoked Risk decreases with time since smoking cessation Single dose of pneumococcal polysaccharide vaccine for all smokers aged 19-64 years
Algorithm for Vaccinating Persons 65 years and older
PPSV23 Revaccination Reimmunization recommended for persons > 65 years if 5+ years since vaccination and <65 years at time of vaccination 2-64 years with asplenia Sickle cell disease
PPSV23 Revaccination Immunocompromised persons >2 years Another dose of PPSV23 after 5 year interval HIV infection generalized malignancy leukemia lymphoma Hodgkins disease multiple myeloma chronic renal failure or nephrotic syndrome Immunosuppressive chemotherapy including corticosteroids organ or hematopoetic stem cell transplant
Pneumococcal Immunization for Immunosuppressed Vaccine naïve PCV13 first; PPSV23 at least 8 weeks later PPSV23-immunized PCV13 at least 1 year after last PPSV23 Recommendations for second dose of PPSV23 and PPSV23 at age 65 years unchanged
Pneumococcal Vaccines for >65 years Vaccine naïve PCV13 first; PPSV23 12months later PPSV23-immunized adults PCV13 at least 1 year after last PPSV23 Note that Medicare pays for a second pneumococcal vaccine >11months after the first dose Recommendation will be reviewed in 2017
Strategies for Improving Vaccination Rates Healthy People 2020 goals:» 90% coverage for those >65 years Current coverage just about 60%» 60% coverage for 18-64 year olds individuals with high risk conditions Current coverage <20% Hospital discharge appropriate time Under approved protocol