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Guideline Summary
Guideline Title
Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23).
Bibliographic Source(s)
Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010 Sep 3;59(34):1102-6. PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997 Apr 4;46(RR-8):1-24. [123 references]

Scope

Disease/Condition(s)

Invasive pneumococcal disease (IPD)

Guideline Category
Prevention
Clinical Specialty
Family Practice
Infectious Diseases
Internal Medicine
Preventive Medicine
Intended Users
Advanced Practice Nurses
Health Care Providers
Nurses
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)

To provide updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for prevention of invasive pneumococcal disease (IPD) (i.e., bacteremia, meningitis, or infection of other normally sterile sites) through use of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) among all adults aged ≥65 years and those adults aged 19–64 years with underlying medical conditions that put them at greater risk for serious pneumococcal infection

Target Population
  • All adults aged ≥65 years
  • Adults aged 19–64 years with underlying medical conditions that put them at greater risk for serious pneumococcal infection
Interventions and Practices Considered

Vaccination through use of the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

Major Outcomes Considered
  • Vaccine effectiveness and efficacy
  • Incidence of invasive pneumococcal disease (IPD)
  • Risk factors for IPD among adults

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Not stated

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Other
Review of Published Meta-Analyses
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

At its June and October 2008 meetings, the Advisory Committee on Immunization Practices (ACIP) approved new and revised recommendations for the use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) to prevent invasive pneumococcal disease (IPD) among adults aged <65 years.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

Not stated

Recommendations

Major Recommendations

Note about the updated recommendations: The new recommendations include the following changes from 1997 Advisory Committee on Immunization Practices (ACIP) recommendations: 1) the indications for which 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination is recommended now include smoking and asthma, and 2) routine use of PPSV23 is no longer recommended for Alaska Natives or American Indians aged <65 years unless they have medical or other indications for PPSV23. ACIP recommendations for revaccination with PPSV23 among the adult patient groups at greatest risk for invasive pneumococcal disease (IPD) (i.e., persons with functional or anatomic asplenia and persons with immunocompromising conditions) remain unchanged. ACIP recommendations for prevention of pneumococcal disease among infants and youths aged ≤18 years using the 13-valent pneumococcal conjugate vaccine (PCV13) and PPSV23 are published separately.

Table. Underlying Medical Conditions or Other Indications for Administration of 23-valent Pneumococcal Polysaccharide Vaccine (PPSV23) among Adults Aged 19–64 years, by Risk Group — Advisory Committee on Immunization Practices (ACIP), 2010

Risk Group Underlying Medical Condition or Other Indication
Immunocompetent persons Chronic heart disease (excluding hypertension)*
Chronic lung disease†
Diabetes mellitus
Cerebrospinal fluid leaks
Cochlear implant
Alcoholism
Chronic liver disease, including cirrhosis
Cigarette smoking
Persons with functional or anatomic asplenia§ Sickle cell disease and other hemoglobinopathies
Congenital or acquired asplenia, splenic dysfunction, or splenectomy
Immunocompromised persons§ Congenital or acquired immunodeficiencies¶
Human immunodeficiency virus (HIV) infection
Chronic renal failure
Nephrotic syndrome
Leukemias
Lymphomas
Hodgkin disease
Generalized malignancy
Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids or radiation therapy
Solid organ transplantation
Multiple myeloma

* Including congestive heart failure and cardiomyopathies.
† Including chronic obstructive pulmonary disease, emphysema, and asthma.
§ A second dose of PPSV23 is recommended 5 years after the first dose for persons with functional or anatomic asplenia and for immunocompromised persons.
¶ Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease).

Updated Recommendations for Administration of PPSV23 among Adults Aged ≥19 Years

  • PPSV23 should be administered to adults aged 19 to 64 years with chronic or immunosuppressing medical conditions, including those who have asthma.
  • Adults aged 19 to 64 years who smoke cigarettes should receive PPSV23 and smoking cessation guidance.
  • Routine PPSV23 use is no longer recommended for Alaska Natives or American Indians aged <65 years unless they have medical indications for PPSV23. However, in certain situations, public health authorities may recommend PPSV23 for Alaska Natives and American Indians aged 50 to 64 years who are living in areas where the risk for invasive pneumococcal disease is increased.
  • All persons should be vaccinated with PPSV23 at age 65 years. Those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose. Those who receive PPSV23 at or after age 65 years should receive only a single dose.
  • ACIP does not recommend routine revaccination for most persons for whom PPSV23 is indicated. A second dose of PPSV23 is recommended 5 years after the first dose for persons aged 19 to 64 years with functional or anatomic asplenia and for persons with immunocompromising conditions. ACIP does not recommend multiple revaccinations because of uncertainty regarding clinical benefit and safety.
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is not specifically stated for each recommendation.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Appropriate use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in the adult population

Potential Harms

Not stated

Qualifying Statements

Qualifying Statements
  • Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
  • References to non-Centers for Disease Control and Prevention (CDC) sites on the Internet are provided as a service to Morbidity and Mortality Weekly Report (MMWR) readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses listed in MMWR were current as of the date of publication.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Foreign Language Translations
Patient Resources
Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010 Sep 3;59(34):1102-6. PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
1997 Apr 4 (revised 2010 Sep 3)
Guideline Developer(s)
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Source(s) of Funding

United States Government

Guideline Committee

Advisory Committee on Immunization Practices (ACIP)

ACIP Pneumococcal Vaccines Working Group

Composition of Group That Authored the Guideline

Report Prepared by: JP Nuorti, MD, DSc, CG Whitney, MD, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), for the Advisory Committee on Immunization Practices (ACIP) Pneumococcal Vaccines Working Group

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997 Apr 4;46(RR-8):1-24. [123 references]

Guideline Availability

Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.

Print copies: Available from the Centers for Disease Control and Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.

Availability of Companion Documents

The following are available:

A variety of additional health provider resources on pneumococcal vaccination are available from the CDC Web site External Web Site Policy.

Patient Resources

The following are available:

  • Pneumococcal polysaccharide vaccine. What you need to know. Vaccine information statement (VIS). Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2009. 2 p. Electronic copies: Available in Portable Document Format (PDF) from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy. Also available in audio and a variety of languages from the CDC Web site External Web Site Policy.
  • Questions about the pneumococcal shot. Brochure. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2009. 2 p. Electronic copies: Available in PDF in English and Spanish from the CDC Web site External Web Site Policy.

A variety of additional patient materials on pneumococcal vaccination are available from the CDC Web site External Web Site Policy.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This summary was completed by ECRI on October 25, 2000. The information was verified by the guideline developer on December 22, 2000. This NGC summary was updated by ECRI Institute on February 17, 2011.

Copyright Statement

No copyright restrictions apply.

Disclaimer

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