Adalimumab is considered immunosuppressive because serious infections have been reported in people taking the drug, including tuberculosis and infections caused by viruses, fungi, or bacteria. Consequently, a person taking adalimumab or other drugs that affect TNF activity such as infliximab [Remicade], certolizumab pegol [Cimzia], golimumab [Simponi], or etanercept [Enbrel] should be considered to have immunosuppression and receive PCV13 followed by PPSV23 at least 8 weeks later.
Please explain why pneumococcal polysaccharide vaccine is recommended for smokers or people with diabetes younger than age 65 but pneumococcal conjugate vaccine is not recommended for these groups. The level of risk for pneumococcal disease in smokers and people with diabetes is not as high as in immunocompromised persons, or persons with asplenia, HIV infection, hematologic cancer, or cochlear implant.
Because of the lower risk, ACIP recommended that smokers and people with diabetes receive only pneumococcal polysaccharide vaccine PPSV, Pneumovax 23; Merck once before age 65 years, and again at age 65 years or older. At this age, pneumococcal disease rates increase regardless of health status. One dose of the pneumococcal conjugate vaccine PCV13; Pfizer is recommended for immunocompromised persons, and persons with asplenia, HIV infection, hematologic cancer, or cochlear implant.
If there is no longer a CSF leak, neither vaccine is recommended, unless there is another risk factor for invasive pneumococcal disease or an age-based indication. Does an adult younger than age 65 years with beta thalassemia minor meet the criteria for a recommendation for vaccination with PCV13? Beta thalassemia minor is a hemoglobinopathy, but compared to sickle cell disease, these patients have less risk for functional asplenia, and by extension a reduced risk for invasive pneumococcal disease.
Wouldn't PPSV23 protect them against ten additional strains of the pneumococcal bacteria? PCV13 is recommended to be given first because of the immune response to the vaccine when given in this sequence.
An evaluation of immune response after a second pneumococcal vaccination administered 1 year after an initial dose showed that subjects who received PPSV23 as the initial dose had lower antibody responses after subsequent administration of PCV13 than those who had received PCV13 as the initial dose followed by a dose of PPSV What is the definition of a year?
Does it need to be exactly one year? We have provided PCV13 to some individuals during flu season this year and told them to get the PPSV23 next year when they get their flu shot. What if they received their flu shot in November this year, but return for their flu shot in October next year? ACIP does not define "one year" but this is assumed to be one calendar year.
However, it could be a problem for reimbursement since Medicare will only pay for both vaccines if they are given at least 11 months apart. Private insurance may have similar rules. Here is the wording from the Centers for Medicare and Medicaid CMS : "An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered i.
We have a year-old patient with a history of vasculitis, nephritis, and asthma. She is on azathioprine Imuran and is immunosuppressed. Her rheumatologist recommends she receive pneumococcal conjugate vaccine and meningococcal B vaccine. How often should these vaccines be given?
Will she require a series of PCV13 doses or just a booster? Meningococcal serogroup B vaccine MenB is not specifically recommended for immunosuppressed people. However, people age 16 through 23 years who are not at increased risk may receive routine MenB vaccination of either a 2-dose series of Bexsero GSK 4 weeks apart, or a 2-dose series of Trumenba Pfizer 6 months apart.
We have a year-old patient taking Mesalamine for ulcerative colitis. Mesalamine mesalazine is a non-steroidal anti-inflammatory drug. It is not immunosuppressive, so it's use would not place a person at increased risk of invasive pneumococcal disease.
Can we administer either the pneumococcal polysaccharide PPSV23 or the pneumococcal conjugate vaccine PCV13 to patients with multiple sclerosis? Multiple sclerosis is not a contraindication to any vaccine, including either of the pneumococcal vaccines. Studies that showed possible interference when PCV7 and Menactra were given simultaneously were done in children.
At this time, there are no data to support a similar recommendation for adults. The first pneumococcal vaccine, licensed in , was a polysaccharide vaccine. It contained purified capsular polysaccharide antigen from 14 different types of pneumococcal bacteria. It replaced the valent vaccine. Who is recommended to receive pneumococcal polysaccharide vaccine PPSV23?
HIV infection Hodgkin disease, leukemia, lymphoma, and multiple myeloma Could you briefly summarize the revaccination recommendations for PPSV23? Children and adults younger than age 65 who are at highest risk for serious pneumococcal infection see categories 9 through 17 in previous answer should get 2 doses of PPSV23 five years apart, with a third dose after they turn age 65 if at least 5 years have passed since the last dose.
Patients with risk factors 1 through 8 above should get one dose of PPSV23 before age 65 and then a second dose after they turn 65 years if at least 5 years have passed since the last dose. Patients with no risk factors should get 1 dose at age Thus, depending on risk and age at vaccination, an adult may have received 1, 2, or 3 doses of PPSV How effective is PPSV23 vaccine for adults 65 years and older? The vaccine is less effective in immunocompromised people.
The effectiveness of this vaccine in preventing noninvasive pneumococcal pneumonia among adults age 65 years and older have been inconsistent. Is a patient younger than age 65 years who recently had a prostatectomy with lymph node dissection for prostate cancer a candidate for PPSV23? The patient is believed to be cancer-free and is on no chemotherapy.
In the absence of "generalized malignancy" which is generally considered to mean disseminated cancer or immunosuppression, a recent history of prostate cancer surgery alone is not an indication for PPSV I have patients who are in their 70s and 80s and remember getting a pneumococcal vaccine a few years ago. Should we assume that this was PPSV23?
Should I assume that it was given before the 65th birthday? Ideally, providers and patients should work to verify which vaccines were received, including by querying the jurisdiction's immunization information system where the patient was likely vaccinated. If vaccination records cannot be obtained, then the patient should be vaccinated. All patients should receive PPSV23 at age 65 years or older. All other vaccines must be documented with a written, dated record. At what age should they receive it?
PPSV23 is recommended for children with an immunocompromising condition, or functional or anatomic asplenia, and also for immunocompetent children with chronic heart disease, chronic lung disease, diabetes mellitus, CSF leak, or cochlear implant. Children with an immunocompromising condition, or functional or anatomic asplenia should receive a second dose of PPSV23 5 years after the first PPSV Is PPSV23 contraindicated in pregnancy?
Our patient has asthma and is pregnant. PPSV23 is recommended in pregnancy if some other risk factor is present for example, on the basis of medical, occupational, lifestyle, or other indication. For more information refer to the adult schedule available at www. Can you please explain when and why the recommendations for vaccination were changed for people with asthma and for cigarette smokers? In , the Advisory Committee on Immunization Practices ACIP reviewed information that suggests that asthma is an independent risk factor for pneumococcal disease among adults.
ACIP also reviewed information that demonstrates an increased risk of pneumococcal disease among smokers. Since PPSV23 is recommended for all adults who smoke, should adults who use smokeless tobacco products e.
ACIP does not identify people who use smokeless tobacco products as being at increased risk for pneumococcal disease or as being in a risk group recommended for vaccination. Since PPSV23 is recommended for all adults who smoke, should adults who vape nicotine, but do not smoke cigarettes, be vaccinated too? ACIP does not identify people who use nicotine vaping products as being at increased risk for pneumococcal disease or as being in a risk group recommended for vaccination.
Should we also vaccinate year-olds who smoke? Currently no data exist to indicate that people younger than 19 and smoke are at increased risk of pneumococcal disease. Is PPSV23 indicated for former smokers? PPSV23 is currently recommended for people age 19 through 64 years who actively smoke cigarettes see www. However, chronic lung disease is an indication for PPSV23, which could be applicable for former smokers.
Does a patient younger than age 65 years who smokes marijuana on a daily basis, but doesn't smoke cigarettes, need to receive pneumococcal polysaccharide PPSV vaccine? ACIP does not identify people who smoke marijuana but not cigarettes as being at increased risk for pneumococcal disease or as being in a risk group for PPSV vaccination.
Is PCV13 recommended for adults age 19 through 64 years who smoke? PCV13 is only recommended for adults age 19 through 64 years at increased risk of invasive pneumococcal disease because of an immunocompromising condition, asplenia, CSF leak or cochlear implant.
Why isn't PPSV23 recommended for children with asthma? Available data do not indicate that asthma alone increases the risk of invasive pneumococcal disease among people younger than 19 years, so PPSV23 is not currently recommended for people younger than 19 years with asthma. For more information, go to www. Would you include obstructive sleep apnea as chronic pulmonary disease which would require PPSV23 vaccination once for adults under the age of 65? Obstructive sleep apnea alone is not an indication for vaccination with PPSV23 for persons 2 through 64 years of age.
People with obstructive sleep apnea often have other pulmonary conditions such as chronic obstructive pulmonary disease that would put them at increased risk for invasive pneumococcal disease, for which they should be vaccinated. A table listing risk conditions and pneumococcal vaccine recommendations can be found at www. Should people who are HIV positive receive pneumococcal vaccines? People with HIV infection are at high risk of pneumococcal disease.
If they are age 65 years or older when first diagnosed, they will need only one dose. Is systemic lupus erythematosus SLE, lupus a risk-based indication for pneumococcal vaccines? Lupus per se is not an indication for either pneumococcal vaccine. However, immunosuppressive medication that may be used to treat lupus could create an indication for administering both pneumococcal vaccines.
Also, if the patient has certain complications of lupus such as nephrotic syndrome , the person would be a candidate for pneumococcal vaccines. A handy document that summarizes indications for both pneumococcal vaccines is available at www.
Does her illness fall under the criteria for administering PPSV23? How often should diabetic patients receive PPSV23? People with either type 1 or type 2 diabetes who are ages 2 through 64 years who have not already received a dose of PPSV23 should receive their first dose now. At age 65 years they should receive a one-time revaccination if 5 years have elapsed since the previous dose.
Diabetes is not an indication for PCV13, however persons 65 years and older may be considered for PCV13 vaccination based on shared clinical decision-making between the provider and patient.
PPSV23 is recommended for people with diabetes. Does this include gestational diabetes? How often should adult dialysis patients receive pneumococcal polysaccharide vaccine?
Once they become age 65, they will need another PPSV23 dose. If they were age 65 years or older when first vaccinated, only one dose of PPSV23 is recommended. Adults age 19 years and older with immunocompromising conditions including chronic renal failure , functional or anatomic asplenia, CSF leak, or cochlear implants, who previously have received 1 or more doses of PPSV23 should be given a PCV13 dose at least 1 year after the last PPSV23 dose was received.
Adults who receive PPSV23 at or after age 65 years should receive only a single dose. A 5-year interval is recommended between PPSV23 vaccine doses. A second PPSV23 given 5 years after the first dose is recommended for people age 19 through 64 years who have functional or anatomic asplenia including persons with sickle cell disease or splenectomy patients ; chronic renal failure including dialysis patients or nephrotic syndrome; are immunocompromised, including those with HIV infection, leukemia, lymphoma, Hodgkin disease, multiple myeloma, generalized malignancy; are receiving immunosuppressive therapy including long-term systemic corticosteroids or radiation therapy ; or who have received a solid organ transplant.
Patients who received 1 or 2 doses of PPSV23 for any indication at age 64 years or younger should receive an additional dose of PPSV23 vaccine at age 65 years or older if at least 5 years have elapsed since their previous PPSV23 dose. Should a healthy year-old patient who was given PPSV23 at age 65 years be revaccinated?
Adults who were first vaccinated at age 65 years or older do not require any more doses of PPSV Why is there no recommendation for patients older than 65 years to get a booster dose of PPSV23 if they first received it at age 65 years or older? It seems to me that their protection against pneumococcal disease would benefit from a booster dose of PPSV23 five or ten years after the first dose.
People age 65 and older should be given a second dose of PPSV23 if they received the first dose 5 or more years previously and were younger than 65 years at the time of the first vaccination. The benefit and safety of a second dose given after age 65 years is uncertain. Until such data are available, ACIP recommends only a single dose at age 65 years or older. Should I still use it? So, although PPSV23 is not as effective as some other vaccines, it can significantly lower the risk of serious pneumococcal disease and its complications in most recipients.
My patient has had laboratory-confirmed pneumococcal pneumonia. There are more than 90 known serotypes of pneumococcus 13 serotypes in the conjugate vaccine and 23 serotypes in the polysaccharide vaccine. Infection with one serotype does not necessarily produce immunity to other serotypes. If influenza vaccine is recommended for healthcare workers to protect high-risk patients from getting influenza, why aren't the pneumococcal vaccines also recommended?
Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness.
Host factors such as age, underlying illness are more important in the development of invasive pneumococcal disease than nasopharyngeal colonization with the organism.
When you're giving influenza vaccine to your patients in the fall, don't forget to assess their need for pneumococcal vaccines as well as all other vaccines, including Tdap and zoster. Why should we not give PCV13 vaccine to someone who has had a serious reaction to a diphtheria-containing vaccine in the past? PCV13 vaccine is conjugated to a type of diphtheria-toxoid.
So if someone has a past history of anaphylaxis following diphtheria-containing vaccine, it might be due to the diphtheria toxoid, and the cause of the anaphylactic allergy should be identified before the administration of PCV13 vaccine. This could be difficult since no single-antigen diphtheria toxoid is available in the U. Fortunately, true anaphylactic allergy to diphtheria-containing vaccine is rare.
If not, what is the recommended interval between doses? What dosing intervals should be observed when giving PCV13 and PPSV23 to patients children and adults who are recommended to receive both vaccines? The introduction of this vaccine into the NHS childhood vaccination schedule has resulted in a large reduction in pneumococcal disease.
Both types of pneumococcal vaccine are inactivated or "killed" vaccines and do not contain any live organisms. They cannot cause the infections they protect against. Find out more about why vaccination is safe and important. Occasionally, you or your child may need to delay having the pneumococcal vaccine or avoid it completely. If there's been a confirmed severe allergic reaction anaphylaxis to the pneumococcal vaccine or any ingredient in the vaccine, it may not be possible for you to have it.
But if it was only a mild reaction, such as a rash, it's generally safe to have the vaccine. If you or your child are mildly unwell at the time of the vaccination, it's safe to have the vaccine. But if you or your child are more seriously ill for example, with a high temperature and feeling hot and shivery , it's best to delay the vaccination until after recovery. Having the pneumococcal vaccine is thought to be safe during pregnancy and while you're breastfeeding.
Like most vaccines, the childhood and adult versions of the pneumococcal vaccine can sometimes cause mild side effects. There are no serious side effects listed for either the childhood or adult versions of the vaccine, apart from an extremely rare risk of a severe allergic reaction anaphylaxis. Find out more about the side effects of the pneumococcal vaccination.
Watch a YouTube video about the story of year-old Sam , who had pneumococcal meningitis as a baby before the childhood pneumococcal vaccine was introduced and was left severely brain damaged. Page last reviewed: 14 February Next review due: 14 February Pneumococcal vaccine overview. At their worst, they can cause permanent brain damage, or even kill. Who should have the pneumococcal vaccine Anyone can get a pneumococcal infection. These include: babies adults aged 65 or over children and adults with certain long-term health conditions, such as a serious heart or kidney condition Babies are offered 2 doses of pneumococcal vaccine, at 12 weeks and at 1 year of age.
These vaccines prevent infections in children who get them, and help stop the infections from spreading to others. Some kids older than age 2 also might need a shot of PCV13 if they have missed one or more shots, especially if they have a chronic health condition or a condition that weakens the immune system. Doctors also recommend PPSV23 immunizations for kids 2—18 years old with some kinds of chronic health conditions.
These include:. Children younger than 2 years old, adults over 65, and people with some medical conditions are at high risk for serious pneumococcal infections. These vaccines are very effective at preventing severe disease, hospitalization, and even death. Kids may have redness, tenderness, or swelling where the shot was given.
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