Dosing and uses of Pneumovax 23 (pneumococcal vaccine polyvalent)
Adult dosage forms and strengths
vaccine
- 0.5mL (1 dose)
Pneumococcal Disease Prevention
Indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine
0.5 mL SC/Im
Up-to-date vaccination schedules available at https://www.cdc.gov/vaccines/schedules/hcp/index.htmL
ACIP Guidelines, Routine Immunization for Immunocompetent Adults
All patients ≥65 years: ACIP recommends routine vaccination with both PPSV23 (23-valent pneumococcal polysaccharide vaccine) and PCV13 (13-valent pneumococcal conjugate vaccine)
MMWR 2015 Sep 4:64(34);944-947
Pneumococcal vaccine-naïve
- Administer PCV13 first, and then PPSV23 ≥1 yr later
Previous vaccination with PPSV23
- A dose of PCV13 should be given ≥1 yr after receipt of the most recent PPSV23 dose
- For those whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6-12 months after PCV13 and ≥5 yr after the most recent dose of PPSV23
ACIP Guidelines, Immunocompromising Conditions
PCV13 recommended in addition to PPSV23 for adults ≥19 yr with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants who have not previously received PCV13 or PPSV23 (MMWR 2012 Oct 12;61[40]:816-819)
Note: minimum interval between PCV13 and PPSV23 is 8 wk for immunocompromised adults
Pediatric dosage forms and strengths
vaccine
- 0.5mL (1 dose)
Pneumococcal Disease Prevention
Indicated for children with high risk conditions including chronic heart or lung disease, diabetes mellitus, cerebrospinal fluid leaks, cochlear implants, anatomic or functional asplenia (including sickle cell disease), or immunocompromised conditions
Do not confuse with routine childhood pneumococcal vaccine PCV13
<2 years: Safety and efficacy not established
≥2 years: 0.5 mL SC/IM for high risk conditions (plus PCV13)
All recommended PCV13 doses should be administered prior to PPSV23 vaccination if possible
Up-to-date vaccination schedules available at https://www.cdc.gov/vaccines/schedules/hcp/index.htmL
ACIP Guidelines, Aged 2-5 Years
Any of the following conditions:
Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure)
Chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy)
Diabetes mellitus Cerebrospinal fluid leak
Cochlear implant
Sickle cell disease and other hemoglobinopathies
Anatomic or functional asplenia
HIV infection
Chronic renal failure
Nephrotic syndrome
Diseases associated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; solid organ transplantation; or congenital immunodeficiency
Dosage for high risk 2-5 years olds
- 1. Administer 1 dose of PCV13 if 3 doses of PCV (7- or 13-valent) were received previously
- 2. Administer 2 doses of PCV (7- or 13-valent) at least 8 weeks apart if fewer than 3 doses of PCV13 were received previously
- 3. Administer 1 supplemental dose of PCV13 if 4 doses of PCV7 or other age-appropriate complete PCV7 series was received previously
- 4. The minimum interval between doses of PCV (PCV7 or PCV13) is 8 wk
- 5. For children with no history of PPSV23 vaccination, administer PPSV23 at least 8 wk after the most recent dose of PCV13
ACIP Guidelines, Aged 6-18 Years
Any of the following conditions:
Cerebrospinal fluid leak
Cochlear implant
Sickle cell disease and other hemoglobinopathies
Anatomic or functional asplenia
Congenital or acquired immunodeficiencies
HIV infection
Chronic renal failure
Nephrotic syndrome
Diseases associated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma
1. If neither PCV13 nor PPSV23 has been received previously, administer 1 dose of PCV13 now and 1 dose of PPSV23 at least 8 wk later
2. If PCV13 has been received previously but PPSV23 has not, administer 1 dose of PPSV23 at least 8 wk after the most recent dose of PCV13
3. If PPSV23 has been received but PCV13 has not, administer 1 dose of PCV13 at least 8 wk after the most recent dose of PPSV23
Heart, lung, diabetes, liver diseases in 6-18 year olds
- Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure)
- Chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy)
- Diabetes mellitus
- Alcoholism
- Chronic liver disease
- If the patient has not received PPSV23, administer 1 dose of PPSV23
- If PCV13 has been received previously, then PPSV23 should be administered at least 8 wk after any prior PCV13 dose
ACIP Guidelines, Revaccination
A single revaccination with PPSV23 should be administered 5 years after the first dose to children with:
Sickle cell disease or other hemoglobinopathies
Anatomic or functional asplenia
Congenital or acquired immunodeficiencies
HIV infection
Chronic renal failure
Nephrotic syndrome
Diseases associated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma
Pneumovax 23 (pneumococcal vaccine polyvalent) adverse (side) effects
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
Frequency not defined
Erythema, induration, soreness at inj site
Low grade fever
Rash
N/V
Lymphadenitis
ITP relapse
Hemolytic anemia
Thrombocytopenia
Anaphylactoid reaction
Angioedema
Serum sickness due to drug
Guillain-Barre syndrome
Warnings
Contraindications
Previous vaccination with pneumococcal vaccine, within 10 days of immunosuppressive therapy
Cautions
Polysaccharide capsular vaccine against 23 strains of pneumococci (90% of blood isolates & 85% of isolates found in sterile sites)
CDC now recommends second dose after 5 years for pts with chronic renal failure, asplenia, HIV infection, cancer, or other conditions associated w/immunosuppression
Splenectomy: administer at least 2 wk before scheduled procedure
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted in breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Pneumovax 23 (pneumococcal vaccine polyvalent)
Mechanism of action
S. pneumoniae capsular antigens stimulate active immune response resulting in production of endogenously produced antibodies
The 23 serotypes contained in the vaccine include: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F
Administration
Instructions
For IM or SC administration
Inject into the deltoid muscle or lateral mid-thigh
