The Advisory Committee on Immunization Practices voted unanimously to recommend a combination regimen of pneumococcal polysaccharide vaccine and pneumococcal conjugate vaccine in immunocompromised adults.
“The reason for focusing on this group of immunocompromised adults is that they have a high burden of disease,” Tamara Pilishvili, MPH, an epidemiologist for the CDC, told the committee. “These adults have a higher risk of invasive pneumococcal disease compared to healthy adults.”
Currently, the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck) is recommended for all adults aged 65 and older and for adults aged 19 to 64 years who have immunocompromising conditions. A second dose of the PPSV23 is recommended 5 years after the first dose. Adding the 13-valent pneumococcal conjugate vaccine (Prevnar 13, Wyeth) to the regimen for immunocompromised adults widens the coverage of the different serotypes of pneumonia.
“We have clear evidence in the reduction of invasive pneumococcal disease caused by additional serotypes in PCV13, which was first evident among children younger than 2 years and evident among adults aged 50 and older,” Matthew Moore, MD, MPH, captain of the US Public Health Service, told the committee.
According to Kathleen Dooling, MD, MPH, of the Respiratory Disease Branch of the National Center for Immunization and Respiratory Disease, half of invasive pneumococcal disease in immunocompromised adults is caused by PCV13 serotypes, and administering the two vaccines provides the opportunity for broader coverage.
Immunocompromised adults include those with functional or anatomic asplenia, cerebrospinal fluid leaks, cochlear implants and other immunocompromising conditions. These conditions include congenital or acquired immunodeficiencies, HIV infection, chronic renal failure, leukemias, lymphomas, Hodgkin’s disease, generalized malignancy, solid organ transplantation, multiple myeloma and disease requiring immunosuppressive drugs.
Two groups comprise immunocompromised adults: vaccine-naive adults and those who have already received a PPSV23 vaccination under current guidelines.
For vaccine-naive adults, the recommendation is that the PCV13 dose be given before the PPSV23 dose, which should be given at least 8 weeks after the PCV13 dose. For those who have already received PPSV23 vaccination, the recommendation is that a dose of PCV13 be given at least 1 or more years after the PPSV23 dose. The current recommendations of a second dose of PPSV23 and a dose at age 65 years remained unchanged for both groups.