CDC expands pneumonia vaccine recommendations

Washington -- The Centers for Disease Control and Prevention now recommends that the pneumococcal vaccine be given to adults who smoke and to those who have asthma. The update, along with other changes to the adult immunization schedule, was published in the Jan. 9 Morbidity and Mortality Weekly Report

These additions, which apply to people age 19 to 64, were approved in October 2008 by the CDC's Advisory Committee on Immunization Practices. Details are available online (link).

Adults 65 or older and those with chronic illnesses have long been advised to get the 23-valent pneumococcal polysaccharide vaccine, or PPSV23.

Smokers' susceptibility to pneumococcal disease became apparent several years ago when a study found that about half of otherwise healthy adults with invasive pneumococcal disease were cigarette smokers. Exposure to smoke also was found to be a risk factor for the illness.

The number of cigarettes smoked and the number of years as a smoker increased the risk, said an editorial on the new immunization guidelines in the Jan. 6 Annals of Internal Medicine.

In recent years, the adult vaccination schedule has gained the attention of health care associations, including the AMA, as physicians are encouraged to use these preventive measures for older patients.

"Since about one-fifth of the U.S. adult population smokes cigarettes, physicians face a considerable challenge to provide them with protection against invasive pneumococcal infection," noted editorial writers Gregory Poland, MD, founder and director of the Mayo Vaccine Research Group at the Mayo Clinic in Rochester, Minn., and William Schaffner, MD, chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Tennessee.

The ACIP also revised guidelines on the use of PPSV23 for Alaska Natives and American Indians younger than 65. Although routine use of the vaccine is not recommended for these populations, physicians now should consider the vaccine for those age 50 through 64 living in areas where there is increased risk of contracting the disease.

Among the additional recommendations and changes:

• Occupational exposure does not increase health workers' risk for human papillomavirus. Workers should receive the HPV vaccine only for standard indications.
• A previous episode of shingles is not a contraindication to zoster vaccination. But most experts recommend waiting at least 12 months between the occurrence of the disease and the vaccination.
• Children age 5 through 18 are advised to receive an annual flu shot, as are the caregivers of people at increased risk for influenza.