Implementation Guide | Pneumococcal Disease

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Pneumococcal Disease

Preventable Deaths

Pneumococcal infection causes an estimated 40,000 deaths annually in the United States, accounting for more deaths than all other vaccine-preventable diseases combined.1,2 Approximately half of these deaths potentially could be prevented through the use of vaccine.1 Pharmacists can play an active role in identifying at-risk patients and advocating pneumococcal vaccinations for these patients.
Streptococcus pneumoniae

Streptococcus pneumoniae, the bacterium which causes pneumococcal disease, causes a variety of infections of the upper respiratory tract (otitis media and sinusitis), lower respiratory tract (pneumonia), and more invasive infections (bacteremia and meningitis).1

    Acute Otitis Media

    S. pneumoniae causes approximately 30%-50% of acute otitis media (AOM) infections.1 While upper respiratory infections usually do not progress to invasive disease, AOM results in more than 24 million visits to pediatricians per year, and 62% of children in the United States experience an episode of AOM during their first year of life.1

    S. pneumoniae is the most common cause of community-acquired pneumonia (CAP) and accounts for approximately 25%-35% of cases of CAP in persons who require hospitalization.1

    Approximately 10%-25% of adult patients with pneumococcal pneumonia develop bacteremia, which has an overall mortality rate of about 20%, but may be as high as 60% among elderly patients.1,2

    S. pneumoniae also has become the most common cause of meningitis in the United States.1 Pneumococcal meningitis has a mortality rate estimated at about 30%, but may be as high as 80% among older adult patients.2

Risk Factors Associated with Pneumococcal Infection

People with the following risk factors are at increased risk of pneumococcal disease.

    65 years of age or older

    Chronic illness, including

        Diabetes mellitus

        Cardiovascular disease

        Pulmonary disease

        Kidney disease*

        Liver disease (e.g. cirrhosis) or alcoholism

    Functional or anatomic asplenia (sickle cell disease or splenectomy)*

    Immunosuppressive conditions*, including

        Human immunodeficiency virus



        Multiple myeloma

        Hodgkins disease

        Generalized malignancy

        Other conditions associated with immunosuppression
        (e.g. organ or bone marrow transplantation)

    Therapy with alkylating agents, antimetabolites, or systemic corticosteroids

    Residents of long-term care facilities or nursing homes

Pneumococcal Vaccine


The Public Health Service objectives for the year 2000 call for vaccinating 60% of persons at risk for pneumococcal disease and 80% of the institutionalized elderly. As of 1993, only 28% of persons age 65 and older had ever received pneumococcal vaccine.1 Missed opportunities to vaccinate are further demonstrated in the facts that over 65% of people hospitalized with serious pneumococcal disease have been admitted to a hospital in the preceding 3 to 5 years, and over 90% of people who die of influenza and pneumococcal disease visited physicians as outpatients in the preceding year.2,3
Pneumococcal Polysaccharide Vaccine

The currently used vaccines (Merck & Company Inc. Pneumovax® 23

and Lederle Laboratories Pnu-Immune® 23) include 23 purified capsular

polysaccharide antigens of S. pneumoniae. These vaccines represent up to 90% of the serotypes that cause invasive pneumococcal infections in the United States, including the 6 serotypes that most frequently cause invasive drug-resistant pneumococcal infection.1
Pneumococcal Vaccine Facts

    Generally, all persons age 65 and older and all persons 2–64 years old who have any of the above risk factors should receive the 23-valent pneumococcal polysaccharide vaccine.1

    Pneumococcal vaccine is given as one 0.5 mL shot and may be given intramuscularly or subcutaneously.1

    Pneumococcal vaccine can be given any time of the year, and can be given concurrently (by separate injection in the other arm) with influenza or other vaccines.1

    If it is not possible to verify a patient’s pneumococcal vaccine status vaccination is recommended.1

    Routine revaccination is not recommended. Revaccination is recommended for people 2 years of age of older who are at highest risk (indicated by * on the previous page) of pneumococcal infection and who are likely to have a rapid decline in pneumococcal antibody levels. Revaccination is also recommended in persons 65 years or older if they were younger than 65 years at the time of primary vaccination. Revaccination is recommended only once, at least 5 years after primary vaccination. Revaccination 3 years after the previous dose may be considered for children at the highest risk for severe pneumococcal infection who would be 10 years of age or younger at the time of revaccination.1

    About half the people who receive the vaccine develop mild, local side effects (e.g. pain, erythema, or swelling at the inject site) which last less than 48 hours. Moderate systemic reactions (e.g. fever and myalgias), more severe local reactions (e.g. local induration) and severe systemic adverse events are rare.1

    Vaccination is contraindicated if the patient is allergic to any of the vaccine components or to a previous pneumococcal vaccination. Persons with moderate to severe illness should not be vaccinated until their condition improves. However, minor illnesses are not a contraindication

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