Class: Vaccine, Inactivated, Bacterial
Dosage Forms. Suspension for Intramuscular Injection: 0.5 mL (13 valent conjugate vaccine, PCV13, Prevnar13); Solution for Intramuscular or Subcutaneous Injection: 0.5 mL (23 valent polysaccharide vaccine, PPSV23, Pneumovax23)
Common FDA Label Indication, Dosing, and Titration.
1. Prevention of invasive pneumococcal disease: Adults 50 y of age or older, single dose IM once (either product); Children, single dose at ages 2, 4, 6, and 12-15 mo as primary series (conjugate product), multiple approved schedules for “catching up” in children who do not start their vaccine series on time
Off-Label Uses.
1. Prevention of invasive pneumococcal disease, immunosuppressed individuals aged 19 y and older: If vaccine naive, single dose PCV13 IM once, followed by single dose PPSV23 IM once in 8 wk; if previously vaccinated with PPSV23, single dose PCV13 IM at least 12 mo after last PPSV23
2. Prevention of invasive pneumococcal disease in individuals at high risk for invasive pneumococcal disease including asplenia, chronic heart disease, chronic lung disease, diabetes, cerebrospinal fluid leak, cochlear implant, alcoholism, chronic liver disease (including asthma if ≥19 y), cigarette smoker ≥19 y, hemaglobinopathy, immunocompromised (congenital or acquired, HIV infection, leukemia, lymphoma, generalized malignancy, iatrogenic immunosuppression, solid organ transplant, multiple myeloma): single dose PPSV23 IM once
3. Prevention of invasive pneumococcal disease in individuals at high risk for invasive pneumococcal disease including asplenia, hemaglobinopathy, immunocompromised: Single dose PPSV23 IM once and repeat single dose IM at 5-y intervals
Drug Characteristics: Pneumococcal Vaccine
Medication Safety Issues: Pneumococcal Vaccine
Drug Interactions: Pneumococcal Vaccine
Adverse Reactions: Pneumococcal Vaccine
Efficacy Monitoring Parameters. Prevention of invasive pneumococcal disease, including bacterial meningitis and ear infections.
Toxicity Monitoring Parameters. Syncope.
Key Patient Counseling Points. None.
Clinical Pearls. PCV13 used for routine immunization of infants and young children and for immunosuppressed adults. PPSV23 should not be used in children younger than 2 y of age. PPSV23 used for individuals with chronic diseases, including immunosuppressive diseases. PPSV23 is used for routine immunization of adults 65 y of age and older. PCV13 contains additional 6 serotypes (compared to Prevnar) against Streptococcus pneumoniae.