Letter to Providers Promoting PPSV for Adults

November 10, 2009 11:00 AM ET

Dear Provider,

We’re writing to urge you to make sure all your patients with indications have received the pneumococcal vaccine.  Approximately 70 million persons with existing pneumococcal polysaccharide vaccine (PPSV) indications are unvaccinated (National Health Interview Survey, 2007). During the influenza pandemics of the 20th century, secondary bacterial pneumonia was a frequent cause of illness and death and Streptococcus pneumoniae (pneumococcus) was reported as the most common etiology. With the current 2009 H1N1 influenza pandemic, and as with seasonal influenza, pneumococcal infections are once again being found among fatal cases in both children and adults.

During influenza outbreaks, pneumococcal vaccines may be useful in preventing secondary pneumococcal infections. As you know, PPSV is available for prevention of pneumococcal disease among adults and children 2 years of age and older who are at increased risk for pneumococcal disease, but many of those with indications have not yet received the vaccine.  A 7-valent pneumococcal conjugate vaccine is recommended for all children <5 years of age.

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends a single dose of PPSV for all people 65 years and older and for persons 2 through 64 years of age with certain high-risk conditions (Box). People in these groups are at increased risk of pneumococcal disease as well as serious complications due to influenza virus infection. A single revaccination with PPSV is recommended at least 5 years after initial vaccination for people 65 years and older who were first vaccinated before age 65. A single revaccination is also recommended for people at highest risk of disease, such as those who have functional and anatomical asplenia, and those who have HIV infection, AIDS or malignancy and have at least five years elapsed from receipt of first vaccination.

All people who have existing indications for PPSV should be vaccinated according to current ACIP recommendations during this 2009-2010 influenza season, which will likely include circulation of both seasonal and 2009 H1N1 influenza viruses. Special emphasis should be placed on vaccinating adults under 65 years of age who have established high-risk conditions; PPSV coverage among this group is very low and this group may be more likely to develop secondary bacterial pneumonia after an influenza infection. Use of PPSV among people without current indications for vaccination is not recommended at this time.

Pneumococcal vaccine may be given at the same time as influenza vaccine. Visits for seasonal and 2009 H1N1 influenza vaccination provide a convenient time to evaluate patients for the need for pneumococcal vaccination. Because the indications for pneumococcal and seasonal influenza vaccines among adults are similar, the need for pneumococcal vaccination should be evaluated at the time of either seasonal influenza vaccination or 2009 H1N1 influenza vaccination. Persons who cannot remember if they’ve ever had pneumococcal vaccine should still be vaccinated.

Sincerely,

Anne Schuchat, MD
Director, National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

High-Risk Indications for Persons 2 through 64 Years of Age

• chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
• chronic pulmonary disease including chronic obstructive pulmonary disease and emphysema
• diabetes mellitus, alcoholism, chronic liver disease (including cirrhosis)
• cerebrospinal fluid leaks, cochlear implant
• functional or anatomic asplenia including sickle cell disease and splenectomy
• immunocompromising conditions including HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant
• residents of nursing homes or long-term care facilities

High-Risk Indications for Persons 19 through 64 Years of Age

• smoke cigarettes or have asthma