Pneumococcus Information for Ob-Gyns
NEW! The New England Journal of Medicine (NEJM) has released an original article, "U.S. Hospitalizations for Pneumonia after a Decade of Pneumococcal Vaccination," which indicates that vaccinating children against pneumococcal pneumonia cut hospitalizations over the past decade in almost all age groups.
RESOURCE: The National Foundation for Infectious Diseases (NFID) has created a new resource, Adult Pneumococcal Vaccination Guide for HCPs, which provides an outline of CDC's adult pneumococcal vaccination schedule. In addition, the NFID has updated their Public Health Resources and Toolkit, Pneumococcal Disease Professional Practice Toolkit, and their Professional Practice Toolkit.
Pneumococcal disease is an infection caused by a type of bacteria called Streptococcus pneumoniae (pneumococcus). Transmission of the pathogen is either person-to-person through respiratory droplets, or by self-inoculation with bacteria previously carried without symptoms in the upper respiratory tract. This bacterium causes the three major clinical syndromes of pneumococcal disease: bacteremia, meningitis, and pneumonia, as well as other lower respiratory tract infections, otitis media, and sinusitis. Mortality from invasive disease (meningitis and bacteremia) is high, particularly among the elderly and the chronically ill. All persons aged 65 years or older or in a high-risk group should receive the pneumococcal polysaccharide vaccine (PPSV) vaccine. While PPSV has a 60–70% protection rate among those with chronic risk conditions, it is still imperative for people in at-risk groups to receive the vaccination.
For adults there is only one PPSV available at this time, Pneumovax 23 (Merck). PPV23, or PPV, is an inactivated vaccine and is licensed in the United States.
Breastfeeding is not a contraindication to PPSV. The vaccine does not adversely affect the safety of breastfeeding women or their infants. Providers should make every effort to vaccinate medically high-risk women before they become pregnant. The vaccine is not contraindicated during pregnancy, but it has not been specifically studied among pregnant women.
Smoking is the single largest independent variable predisposing nonelderly, immunocompetent adults to invasive pneumococcal disease. ACIP also includes smoking as an indication for PPSV.
Those at high risk for contracting pneumococcal infection include all persons over 65 years of age. It is indicated for individuals aged 2–65 years who have chronic cardiovascular diseases, chronic pulmonary diseases, chronic liver diseases, diabetes mellitus, alcohol abuse, functional or anatomical asplenia cerebrospinal fluid leak, cochlear implant, or asthma. Individuals with immunosuppressive conditions: human immunodeficiency virus (HIV), leukemia, generalized malignancy, congenital immunodeficiency, or those immunosuppressed from chemotherapy or high-dose corticosteroid therapy should also receive the vaccination. Individuals with lymphoma, multiple myeloma, or Hodgkin’s disease; organ or bone marrow transplant patients; individuals on alkylating agent therapy; individuals with nephrotic syndrome; and individuals with chronic renal failure are also at increased risk for pneumococcal infection. The ACIP recommends the pneumococcal vaccine for persons receiving cochlear implants, preferably at least 2 weeks prior to surgically receiving the implant. Further, persons 5–64 years of age who currently have cochlear implants should receive PPSV.
The contraindications for PPSV are a severe allergic reaction (eg, anaphylaxis) after a previous vaccine dose or to a vaccine component. Individuals with moderate or severe acute illness should postpone vaccination. PPSV is one of three vaccines covered by Medicare. Medicare covers one dose per individual per lifetime, though it does cover a booster for high-risk adults if 5 years have passed since their last PPSV immunization.
Last Updated: 8/2/2013
Pneumococcus Information for Patients
Pneumococcal disease is an infection caused by a type of bacteria called Streptococcus pneumoniae. The bacteria spread easily among people and can cause lower respiratory tract infections, otitis media, and sinusitis. Infections can be more serious or life-threatening in some people. In older adults and in people with long-term illness especially, the infection can cause bacteremia (bacteria in the bloodstream), meningitis, and pneumonia. The infection can also cause long-term problems, such as brain damage or hearing loss.
All persons aged 65 years or older or at high risk for infection should get the pneumococcal polysaccharide vaccine (PPSV). The PPSV is the best way to protect against developing severe illness or death. People aged 2–64 years with long-term illness or on certain long-term drugs are also at high risk for infection and should get the PPSV vaccine.
Certain people are at high risk for developing serious illness from infection. Individuals in this group include all adults aged 65 years and older as well as people age 2–65 years with certain conditions. These include:
• People who smoke
• People who have long-term heart, lung, kidney, or liver disease
• People who leak cerebrospinal fluid
• People who have or are getting cochlear implants
• People with weakened immune systems due to disease, such as HIV, AIDS, or cancer
• People with weakened immune systems due to medication, such as long-term steroids or
• People who have organ or bone marrow transplants
People who should not get the PPSV include those who have had a severe allergic reaction to a vaccine before. People with current serious illness should wait until they are better to get the PPSV. Mild illnesses, such as a minor lower respiratory tract infection, do not require waiting to get the vaccine.
It is safe to get the PPSV while breastfeeding. The vaccine does not harm breastfeeding women or their infants. If you are in a high-risk group and could become pregnant, you should get the vaccine before becoming pregnant. Health care providers do not know if the PPSV is safe for babies during pregnancy.
PPSV is one of three vaccines covered by Medicare. Medicare covers one dose per person. It also covers a booster for high-risk adults if it has been at least 5 years since their last PPSV.
For more information, visit the Centers for Disease Control and Prevention's section on pneumococcal vaccination.
Last Updated: 8/2/2013