Smoking, Asthma Now Constitute Indications for Pneumococcal Vaccination

The AAFP has adopted recommendations (1-page PDF; About PDFs) from the CDC's Advisory Committee on Immunization Practices, or ACIP, for the 23-valent pneumococcal polysaccharide vaccine, or PPSV23.

The provisional recommendations added smoking and asthma as indications for routine administration of PPSV23 in adults ages 19-64.

"That's pretty significant," said Doug Campos-Outcalt, M.D., M.P.A., who serves as the AAFP's liaison to ACIP and is associate head of the Department of Family and Community Medicine and assistant dean for outreach and multicultural affairs at the University of Arizona College of Medicine, Phoenix. "There are a lot of patients out there who are smokers, have asthma or both. Smoking and asthma are significant risks for pneumococcal pneumonia."

ACIP also revised its pneumococcal immunization recommendations for American Indians and Alaska Natives, as well as for high-risk children.

In its 2007-08 adult immunization schedule, ACIP listed Alaska Natives and certain American Indian populations as indicated to receive the vaccine. However, ACIP said in its new provisional recommendations that PPSV23 is not recommended for routine use in those ethnic groups for people younger than age 65 "unless they have underlying medical conditions that are PPSV23 indications." The committee also said that public health officials may recommend that American Indians and Alaska Natives ages 50-64 receive the vaccine if they live in areas with an increased risk of invasive pneumococcal disease.

Similarly, ACIP said that routine use of PPSV23 after the normal childhood series of seven-valent pneumococcal conjugate vaccine, or PCV7, doses is not recommended in Alaska Native and American Indian children ages 24 through 59 months, but the committee noted that public health officials may recommend an exception for children in these groups who live in areas with an increased risk of invasive disease.

Overall, ACIP recommends administration of PPSV23 instead of PCV7 for children ages 2 years or older who have certain medical conditions. In addition, the revised pneumococcal immunization recommendations call for revaccination five years after the first dose of PPSV23 for people age 2 years or older who are immunocompromised, have sickle cell disease, or have functional or anatomic asplenia.

The 2009 childhood, adolescent and catch-up immunization schedules were released Jan. 6 by the CDC, the AAFP and the American Academy of Pediatrics; the new adult immunization schedule is expected to be released on Jan. 9.