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Whom should you vaccinate?
The CDC^a published ACIP^b recommendations for pneumococcal vaccination.^c

^aCenters for Disease Control and Prevention.
^bAdvisory Committee on Immunization Practices.
^cFor detailed information about the ACIP recommendations, please see Centers for Disease Control and Prevention (CDC).
Prevention of pneumococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR. 1997;46(RR-08):1–24.
^dIncluding patients who have undergone organ or bone marrow transplant and those receiving immunosuppressive
chemotherapy.

PNEUMOVAX^®23 (Pneumococcal Vaccine Polyvalent) is indicated for vaccination against pneumococcal disease caused by those pneumococcal types included in the vaccine.

Select Safety Information
PNEUMOVAX 23 is contraindicated in individuals who are hypersensitive to any component of the vaccine.

PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine.

The most common adverse experiences reported with PNEUMOVAX 23 in clinical trials were: Local reaction at injection site including soreness, erythema, warmth, swelling and induration; and fever <102°F.

In post-marketing experience, injection site cellulitis-like reactions were reported rarely; between 1989 and 2002, when approximately 43 million doses were distributed, the annual reporting rate was <2/100,000 doses. These cellulitis-like reactions occurred with initial and repeat vaccination at a median onset time of 2 days after vaccine administration. Systemic signs and symptoms including fever, leukocytosis and an increase in the laboratory value for serum C-reactive protein may be associated with local reactions.

If the vaccine is used in persons receiving immunosuppressive therapy, the expected serum antibody
response may not be obtained and potential impairment of future immune responses to pneumococcal
antigens may occur.

Vaccination with PNEUMOVAX 23 may not offer 100% protection from pneumococcal infection.

PNEUMOVAX 23 is not indicated in children less than 2 years of age. Safety and effectiveness in children below the age of 2 years have not been established. Children in this age group respond poorly to the capsular types contained in this vaccine.

When is the right time for revaccination?
The CDC^a published ACIP^b recommendations for pneumococcal revaccination for the following patients:

^aCenters for Disease Control and Prevention.
^bAdvisory Committee on Immunization Practices.
^cIncluding sickle cell disease and splenectomy.
^dIncluding congestive heart failure and cardiomyopathies.
^eIncluding chronic obstructive pulmonary disease and emphysema.
^fIncluding cirrhosis.

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In a clinical trial, an increased rate of local reactions has been observed with revaccination at 3 to 5 years following primary vaccination. This increase was greater among subjects >65 years of age (79.3% vs 52.9%) than among subjects 50 to 64 years of age (79.6% vs 72.8%). In both age groups, revaccinees reported a higher rate of a composite end point (any of the following: moderate pain, severe pain, and/or large induration at the injection site) than primary vaccinees (age >65 years: 30.6% vs 10.4%; age 50 to 64 years: 35.5% vs 18.9%). The rate of vaccine-related systemic adverse experiences was higher following revaccination than primary vaccination in subjects >65 years of age (33.1% vs 21.7%), and was similar following revaccination and primary vaccination in subjects 50 to 64 years of age (37.5% vs 35.5%).

Because data are insufficient concerning the safety of pneumococcal vaccine when administered three or more times, revaccination following a second dose is not routinely recommended.

Any febrile respiratory illness or other active infection is reason for delaying use of PNEUMOVAX 23, except when, in the opinion of the physician, withholding the agent entails even greater risk.

Before administering PNEUMOVAX 23, please read the Prescribing Information.

PNEUMOVAX 23 is a registered trademark of Merck & Co., Inc.

Reference: 1. Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 1997;46(RR-8):1–24.