October 12, 2012
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CDC recommends combined pneumococcal vaccine regimen

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The CDC recommends that adults aged 19 years and older who have immunocompromising conditions receive the 13-valent pneumococcal conjugate vaccine combined with the 23-valent pneumococcal polysaccharide vaccine.

This recommendation also applies to adults with functional or anatomic asplenia, cerebrospinal fluid leaks or cochlear implants, according to findings in the Morbidity and Mortality Weekly Report.

Adults with these conditions who have not yet received any pneumococcal vaccine should first receive a dose of PCV13 (Prevnar13, Wyeth), followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck) at least 8 weeks later. A second dose of PPSV23 is recommended 5 years after the first dose for those with functional or anatomic asplenia and for those with immunocompromising conditions.

PCV13 was licensed by the FDA for adults aged at least 50 years for the prevention of pneumonia and invasive pneumococcal disease based on immunogenicity studies that showed similar or better antibody response than PPSV23. Previously, the PPSV23 vaccine was the only pneumococcal vaccine recommended for adults aged at least 65 years and for high-risk adults aged 19 to 64 years.

“Although conflicting evidence regarding PPSV23 efficacy in HIV-infected adults has been published, the GRADE evaluation reviewed by the [Advisory Committee on Immunization Practices] concluded that potential benefits from PPSV23 use in this population outweigh any potential harms,” the CDC wrote. “Given the high burden of invasive pneumococcal disease caused by serotypes in PPSV23 but not in PCV13, broader protection might be provided through use of both pneumococcal vaccines.”

In a cost-effectiveness analysis in which those with HIV/AIDs and those requiring analysis received the newly recommended vaccine sequence, a cost savings of $7.6 million was achieved. The vaccination program added 1,360 quality-adjusted life years and prevented 57 cases of invasive pneumococcal disease, according to the MMWR report.

Disclosure: The authors report no relevant financial disclosures.