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IMMUNIZATIONS John D.
Grabenstein, Section Advisor
Pneumococcus vaccines recommended to decrease secondary infections
associated with H1N1, seasonal influenza
Key point: CDC Advisory Committee on Immunization
Practices (ACIP) recently recommended that all individuals older than 65
years and certain high-risk patients be vaccinated against
Streptococcus pneumoniae (pneumococcus) using the 23-valent
pneumococcal polysaccharide vaccine (PPSV). In addition, all children
younger than 5 years should be vaccinated with pneumococcal conjugate
vaccine (PCV7) in accordance with existing infant immunization
guidelines.
Finer points: Influenza viruses predispose patients
to developing bacterial infections. During previous influenza pandemics,
secondary bacterial pneumonia caused by pneumococcus was a common cause
of illness and death. During this influenza season, some of CDC’s
Active Bacterial Core surveillance sites have reported increased
incidence of invasive pneumococcus and influenza-related hospital
admissions. Although a casual relationship has not yet been established,
CDC and state and local public health officials are investigating the
situation.
Most experts agree that pneumococcus vaccines are useful in
preventing secondary pneumococcal infections and in reducing the
comorbidities and comortalities associated with pneumococcus infections.
New CDC guidelines recommend that all persons older than 65, and those
aged 2 through 64 with certain high-risk conditions, be vaccinated with
a single dose of PPSV. According to the guidelines, high-risk patients
include those suffering from chronic cardiovascular disease, chronic
pulmonary disease, type 2 diabetes, alcoholism, chronic liver disease,
cerebrospinal fluid leaks, functional or anatomic asplenia, and
immunocompromised conditions. Patients who have cochlear implants or who
reside in nursing homes or long-term care facilities are also considered
high-risk.
The guidelines also recommend booster pneumococcal vaccinations in
some cases. Persons older than 65 years who were first vaccinated before
the age of 65 should receive a single booster vaccination at least 5
years after initial vaccination. People at highest risk of
disease—including patients who have functional and anatomical
asplenia, HIV infection, AIDS, or malignancies—should have a
single booster vaccination if at least 5 years has elapsed since the
previous pneumococcus vaccination.
In addition, all children 5 years of age and younger should continue
to receive PCV7, according to infant immunization guidelines.
What you need to know: The guidelines recommend the
use of a commercially available urine antigen test (Binax
NOW—Inverness Medical) to help diagnose pneumococcal pneumonia in
adults. This test, in conjunction with blood cultures, can assist
clinicians in determining if a secondary pneumococcal pneumonia is
present and can help facilitate prescribing antibiotics in a timely
manner.
What your patients need to know: Encourage all
patients older than 65 years of age and patients at high risk for
developing pneumococcus infections to be vaccinated with PPSV.
Pneumococcus vaccines may be given at the same time as the H1N1 and/or
seasonal influenza vaccines. Patients for whom the pneumococcal vaccine
is indicated and who cannot remember if they have had the vaccine should
be revaccinated. CDC does not recommend administering PPSV to people
without current indications.
Sources
Related resources on www.pharmacist.com
Posted by Joe Sheffer (jsheffer@aphanet.org)
November 25, 2009
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