Facts About Pneumococcal Disease and Prevention in Adults

Pneumococcal Disease Epidemiology and Disease Burden

• Pneumococcal disease is caused by Streptococcus pneumonia, which is transmitted through respiratory droplets.
• Its most serious clinical manifestations are invasive disease (bacteremia, or blood infections, and meningitis) and pneumonia.
• Annual estimated US incidence:
  • Bacteremia: 50,000
  • Meningitis: 3,000-6,000
  • 85 percent of IPD occurs in adults
• Pneumococci are a major cause of the 900,000 cases of community-acquired pneumonia (CAP) in the US each year. Approximately 175,000 annually are hospitalized in the US with pneumococcal pneumonia.
• Pneumococcal disease death rates:
  • Bacteremia: 15 to 20 percent
  • Meningitis: 16 to 37 percent
  • Pneumonia: 5 to 7 percent
• Pneumococcal disease has high associated morbidity.
  • Pneumococcal meningitis can cause hearing loss, seizures, blindness, and paralysis. Concurrent cardiac events are common among patients hospitalized with pneumococcal pneumonia.
• Symptoms develop suddenly and vary by clinical presentation:
  • Pneumonia: fever, shaking chills, cough, shortness of breath, chest pain
  • Meningitis: stiff neck, fever, disorientation, sensitivity to light
  • Bacteremia: similar to meningitis and pneumonia, with muscle and joint pain
  • In the elderly, symptoms may be atypical and might include weakness or confusion without the presence of a fever or other more common symptoms

Pneumococcal Vaccination
Two pneumococcal vaccines are approved by the US Food and Drug Administration for use in adults: a 23-valent pneumococcal polysaccharide vaccine (PPSV23) indicated for all adults and a 13-valent pneumococcal conjugate vaccine (PCV13) indicated for adults age 50 years and older. The Centers for Disease Control and Prevention (CDC) recommends one or both of these vaccines for adults with pneumococcal risk factors.

CDC recommends only PPSV23 for the following adults:
        • Age 65 years and older
        • Age 19-64 years of age with: asthma, diabetes, lung, heart, or liver disease, or alcoholism
        • Cigarette Smokers
        • Residents of long-term or chronic care facilities (eg, nursing homes)
        • Alaska Native and American Indian adults age 50-64 years if recommended by local public health   authorities in areas where risk of invasive disease is increased

PPSV23 Revaccination: Those who received one dose of PPSV23 before age 65 years for any indication should receive another dose at age 65 years, or later if at least five years has elapsed.

CDC recommends both PCV13 and PPSV23 for adults age 19 years and older with:
        • Immunocompromising conditions (such as: HIV, lymphoma, leukemia, or Hodgkin disease, chronic kidney disease)
        • Functional or anatomic asplenia
        • Cochlear implants or cerebrospinal fluid leaks

The number and timing of doses for these adults varies. For more information, refer to the Adult Pneumococcal Vaccination Guide for HCPs or visit: www.cdc.gov/vaccines/vpd-vac/pneumo/.

• Mild side effects include redness or pain at the injection site. In rare cases fever, muscle aches, or more severe site reactions may develop.
• Vaccination can be administered any time of year and can be given at the same time as influenza vaccine.

Vaccination Rates and Ethnic and Racial Disparities

• African American, Hispanic, Asian, American Indian, and Alaska Native populations experience higher rates of risk conditions for pneumococcal disease and lower vaccination rates:
  • Vaccination rates for African American adults are 47.6 percent for those ≥65 years.
  • Rates among Hispanic adults are 43.1 percent for those ≥65 years and 18.3 percent for working age adults.
  • Rates among Asian adults are 40.3 percent for those ≥65 and 12 percent for working age adults.
• The overall vaccination rate in persons ≥65 years is 62.3 percent; the US public health goal is 90 percent.
• In adults age 19-64 years with risk conditions the overall vaccination rate is 20.1 percent; the goal is 60 percent.
• Approximately 73 million US adults have an indication for pneumococcal vaccination, but have not been vaccinated.

For more information, visit www.adultvaccination.org

February 2013