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Review

Navigating pneumococcal vaccination in adults

Andrea Pallotta, PharmD, BCPS (AQ-ID), AAHIVP and Susan J. Rehm, MD, FACP, FIDSA
Cleveland Clinic Journal of Medicine June 2016, 83 (6) 427-433; DOI: https://doi.org/10.3949/ccjm.83a.15044
Andrea Pallotta
Clinical Pharmacy Specialist, Infectious Diseases/HIV, Department of Pharmacy, Cleveland Clinic
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  • For correspondence: pallota@ccf.org
Susan J. Rehm
Vice Chair, Department of Infectious Diseases, Cleveland Clinic
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    FIGURE 1

    Incidence of pneumococcal disease in adults age 50 and older in the United States.

    Information from references 2 and 3.

  • FIGURE 2
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    FIGURE 2

    Intervals of administration of pneumococcal conjugate vaccine-13 (PCV13) and pneumococcal polysaccharide vaccine-23 (PPSV23) in adults age 65 and older.

    Information from references 3 and 14.

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    FIGURE 3

    Intervals of administration of pneumococcal conjugate vaccine-13 (PCV13) and pneumococcal polysaccharide vaccine-23 (PPSV23) in immunocompromised patients.

    Information from reference 16.

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    TABLE 1

    Indications for PCV13 and PPSV23 for at-risk adultsa

    Risk groupPCV13PPSV23PPSV23 revaccination 5 years after first dose
    At-risk patients ages 19 to 64 with comorbid conditions
    Immunocompetent persons with chronic heart disease,b chronic lung disease,c diabetes mellitus, alcoholism, chronic liver disease, cirrhosis, or cigarette smokingNoYesNo
    Persons with cerebrospinal fluid leak or cochlear implantsYesYesNo
    Immunocompromised and asplenic patients
    Persons with functional or anatomic asplenia (sickle cell disease, other hemoglobinopathy, or congenital or acquired asplenia)YesYesYes
    Immunocompromised persons, ie, with congenital or acquired immunodeficiency,d human immunodeficiency virus infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression,e solid organ transplant, or multiple myelomaYesYesYes
    • PCV13 = pneumococcal conjugate vaccine-13; PPSV23 = pneumococcal polysaccharide vaccine-23

    • ↵a All adults age 65 and older should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine.

    • ↵b Including congestive heart failure and cardiomyopathies, excluding hypertension.

    • ↵c Including chronic obstructive pulmonary disease, emphysema, and asthma.

    • ↵d Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease).

    • ↵e Diseases requiring treatment with immunosuppressive therapy, including long-term systemic corticosteroids and radiation therapy.

    • Adapted from US Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816–819.

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Cleveland Clinic Journal of Medicine: 83 (6)
Cleveland Clinic Journal of Medicine
Vol. 83, Issue 6
1 Jun 2016
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Navigating pneumococcal vaccination in adults
Andrea Pallotta, Susan J. Rehm
Cleveland Clinic Journal of Medicine Jun 2016, 83 (6) 427-433; DOI: 10.3949/ccjm.83a.15044

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Navigating pneumococcal vaccination in adults
Andrea Pallotta, Susan J. Rehm
Cleveland Clinic Journal of Medicine Jun 2016, 83 (6) 427-433; DOI: 10.3949/ccjm.83a.15044
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  • Article
    • ABSTRACT
    • STRIKES THE VERY YOUNG, VERY OLD, AND IMMUNOCOMPROMISED
    • TWO INACTIVATED VACCINES
    • PPSV23 AND PCV13 ARE NOT THE SAME
    • HOW EFFECTIVE ARE THEY?
    • AT-RISK PATIENT POPULATIONS
    • ADULTS AGE 65 AND OLDER: ONE DOSE EACH OF PCV13 AND PPSV23
    • AT-RISK PATIENTS AGES 19 TO 64
    • IMMUNOCOMPROMISED AND ASPLENIC PATIENTS
    • ADDRESSING BARRIERS TO PNEUMOCOCCAL VACCINATION
    • AN OPPORTUNITY TO IMPROVE
    • REFERENCES
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