Pneumococcal Vaccine

Only one type of pneumococcal vaccine, polysaccharide vaccine, is used in the elderly. The other type, pneumococcal conjugate vaccine, has not been evaluated in the elderly and is used mainly in children and immunosuppressed patients; it immunizes against 7 capsular types. The polysaccharide vaccine contains 23 polysaccharides, derived from the 23 pneumococcal capsular types that account for most bacteremic pneumococcal infections in adults in the US.

The incidence of invasive pneumococcal infection begins to increase at about age 50 and increases sharply at age 65. Blacks and American Indians of any age are more susceptible to invasive pneumococcal infection; they are also more likely to have conditions that increase risk of this infection. Such conditions include sickle cell disease, nephrotic syndrome, splenic dysfunction, anatomic asplenia (eg, surgical splenectomy), chronic renal failure, SLE, diabetes mellitus, chronic cardiopulmonary disorders, and certain immunosuppressive disorders (eg, leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma).

The increasing prevalence of antibiotic resistance among strains of Streptococcus pneumoniae makes widespread use of pneumococcal vaccine crucial.

The vaccine is recommended for all people at age 65. However, in the US, < 50% of adults > 65 have been immunized with pneumococcal vaccine. The vaccine is effective in most healthy elderly people but is less effective in people who have a condition that increases risk (eg, immunosuppression, cardiopulmonary disorders, cancer) and in the very old. Immunization probably reduces the incidence of pneumonia, secondary pneumococcal sepsis, and mortality.

Pneumococcal vaccine is given IM only once, rather than annually. If vaccination status is uncertain, giving the vaccine is safer than not giving it, although revaccination increases risk of local irritation. People vaccinated before age 65 should be given a 2nd dose at age 65 if initial immunization occurred > 6 yr earlier. The Advisory Committee on Immunization Practices recommends one-time revaccination after 5 yr for people with nephrotic syndrome, chronic renal failure, splenic dysfunction, anatomic asplenia, or an immunosuppressive disorder.

This topic was last updated February 2006.