No

Vaccine

Children >2 years of age and adults who are at increased risk of pneumococcal disease and its complications because of underlying health conditions; older adults, including all those greater than or equal to 65 years of age

C

The safety of vaccine in pregnant women has not been evaluated; it should not be given during pregnancy unless the risk of infection is high

Active infections, Hodgkin's disease patients, <2 years of age, pregnancy, hypersensitivity to pneumococcal vaccine or any component; <10 days prior to or during treatment with immunosuppressive drugs or radiation; (children <5 years of age do not respond satisfactorily to the capsular types of 23 capsular pneumococcal vaccine; the safety of vaccine in pregnant women has not been evaluated; it should not be given during pregnancy unless the risk of infection is high)

Epinephrine injection (1:1000) must be immediately available in the case of anaphylaxis; use caution in individuals who have had episodes of pneumococcal infection within the preceding 3 years (pre-existing pneumococcal antibodies may result in increased reactions to vaccine); may cause relapse in patients with stable idiopathic thrombocytopenia purpura

All serious adverse reactions must be reported to the U.S. Department of Health and Human Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967.

<1%: Guillain-Barré syndrome, low-grade fever, erythema, rash, paresthesias, myalgia, arthralgia, anaphylaxis

Decreased effect with immunosuppressive agents, immunoglobulin, other live vaccines within 1 month

Refrigerate

Although there are more than 80 known pneumococcal capsular types, pneumococcal disease is mainly caused by only a few types of pneumococci. Pneumococcal vaccine contains capsular polysaccharides of 23 pneumococcal types which represent at least 98% of pneumococcal disease isolates in the United States and Europe. The pneumococcal vaccine with 23 pneumococcal capsular polysaccharide types became available in 1983. The 23 capsular pneumococcal vaccine contains purified capsular polysaccharides of pneumococcal types 1, 2, 3, 4, 5, 8, 9, 12, 14, 17, 19, 20, 22, 23, 26, 34, 43, 51, 56, 57, 67, 70 (American Classification). These are the main pneumococcal types associated with serious infections in the United States.

Children >2 years and Adults: I.M., S.C.: 0.5 mL

1. If greater than or equal to 6 years since initial vaccination has elapsed, or

2. In patients who received 14-valent pneumococcal vaccine and are at highest risk (asplenic) for fatal infection or

3. At greater than or equal to 6 years in patients with nephrotic syndrome, renal failure, or transplant recipients, or

4. 3-5 years in children with nephrotic syndrome, asplenia, or sickle cell disease

Do not inject I.V., avoid intradermal, administer S.C. or I.M. (deltoid muscle or lateral midthigh)

None reported

None reported

Be aware of adverse effects

Injection: 25 mcg each of 23 polysaccharide isolates/0.5 mL dose (0.5 mL, 1 mL, 5 mL)

Advisory Committee on Immunization Practices, "Prevention of Pneumococcal Disease," MMWR Morb Mortal Wkly Rep, 1997, 46(RR-8):1-31.

Davidson M, Bulkow LR, Grabman J, et al, "Immunogenicity of Pneumococcal Revaccination in Patients With Chronic Disease," Arch Intern Med, 1994, 154(19):2209-14.

Gardner P and Schaffner W, "Immunization of Adults," N Engl J Med, 1993, 328(17):1252-8.

U.S. Department of Health and Human Services, "Prevention of Pneumococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP)," MMWR Morb Mortal Wkly Rep, 1997, 46(RR-8):1-24.