New Vaccine Recommendation for Adults

PCV13 vaccine recommended for immune compromised individuals

(RxWiki News) Adults with certain immune system conditions often require different recommendations for the vaccines they can and should receive. A new vaccine has been added to these recommendations.

Most patients with weakened immune systems should already receive a vaccine called PPSV23. This medication protects them against a variety of bacterial strains that can cause meningitis or pneumonia.

Now the CDC committee that recommends vaccine schedules has said that these adults can and should also get a vaccine called PCV13. This will protect them against additional bacterial strains.

"Follow the CDC's immunization schedule."

The recommendations, written by committee member Nancy M. Bennett, MD, come from a report from the Advisory Committee on Immunization Practices at the US Centers for Disease Control and Prevention.

The current vaccine that immunocompromised adults should receive is called 23-valent pneumococcal polysaccharide vaccine (PPSV23). The new one for this group is called 13-valent pneumococcal conjugate vaccine (PCV13).

They both protect against different strains of the bacteria called Streptococcus pneumoniae. This bacteria can cause various serious illnesses, including meningitis, pneumonia and other bacterial diseases that kill about 4,000 people every year.

This bacteria is especially dangerous for those with certain types of cancer and those with HIV.

When children began receiving PCV13 in 2010, the number of infections from the bacteria dropped among children and adults. However, it did not stop them completely.

Researchers were not sure whether they could safely give PCV13 to adults with immune-compromising conditions. This uncertainty left these adults without protection from additional strains of the bacteria.

While about 21 percent of adult infections were caused by the bacteria strains included in the PPSV23 shot, about 50 percent were caused by the strains included in the PCV13 shot.

Then two studies were conducted in the US and Europe to test the effectiveness of the PCV13 in adults. A safety study on PCV13 was also conducted that included about 6,000 adults aged 50 and older.

Less than 2 percent of the participants who got the vaccine and who got a placebo injection reported serious adverse events, and there were not major differences between the groups.

The most common adverse reactions from the shot were pain, redness and swelling where the individual got the shot, fatigue and headache.

These trials did not include immunocompromised adults, but a different study of 496 people with HIV in Malawi did show the PCV13 vaccine to be 75 percent effective in protecting against invasive pneumococcal disease, which is caused from the S. pneumoniae bacteria.

Those who received the vaccine in this study also had fewer adverse events than the group who received a placebo injection.

Currently, ACIP recommends that adults aged 19 to 64 who have a condition placing them at high risk for invasive pneumococcal disease should get the PPSV23 shot. They should get a booster five years later if they are still immunocompromised or have functional or anatomic asplenia (a spleen disorder).

The adults who should now also get the PCV13 shot include those who have cochlear implants, cerebrospinal fluid leaks, sickle cell disease, other blood-related diseases or congenital or acquired asplenia. Immunocompromised adults should also get the PCV13 now.

The report was published in JAMA on January 22, as reprinted from the CDC's Morbidity and Mortality Weekly Report.

Review Date: 
January 22, 2013