How serious is pneumococcal disease?
An estimated 40,000 cases of invasive pneumococcal disease occur annually. Case-fatality rates are high, particularly when disease results in meningitis (~30%) or bacteremia (~20%). In addition, pneumococcal pneumonia, often a secondary complication of influenza, results in an estimated 175,000 hospitalizations annually.

My patient doesn't have a record of receiving PPV, but she believes she may have had it in the past. What should I do?
Persons with uncertain or unknown vaccination status should be vaccinated.

Should all nursing home patients be vaccinated against pneumococcal disease?
Yes. Standing orders for vaccination of persons admitted to long-term care facilities can help simplify the procedure.

Should people with asthma receive PPV?
Asthma is not an indication for routine pneumococcal vaccination unless it occurs with chronic bronchitis, emphysema, or long-term systemic corticosteroid use. However, persons with obstructive lung disease should be vaccinated regardless of the cause.

My patient has had pneumococcal pneumonia. Is vaccination still necessary?
Maybe. More than 80 known serotypes of pneumococcus exist; 23 serotypes are in the current vaccine. Infection with one serotype does not necessarily produce immunity to other serotypes. Please note, however, that vaccination is indicated only for those in a risk group (click here to see table below). A history of pneumococcal pneumonia alone is not an indication for vaccination with PPV unless other risk factors are present (click here to see table below).

Should HIV-positive patients receive PPV?
Yes. Patients with HIV infection should be given PPV as soon as possible after diagnosis and a one-time revaccination dose at the appropriate interval (click here to see table below). The risk of pneumococcal infection is up to 100 times greater in HIV-infected persons than in other adults of similar age. Although severely immunocompromised persons may not respond well to the vaccine, the risk of disease is great enough to warrant vaccination even though there is a chance that the vaccine may not produce an antibody response.

If I give PPV to my patient now, must I wait a month before giving influenza or Td vaccine?
Inactivated influenza vaccine and Td toxoids may be given at the same time as or at any time before or after a dose of PPV. There are no minimum interval requirements between the doses of these or any other inactivated vaccines.

When should I vaccinate patients who are planning to have either a cochlear implant or elective splenectomy?
If time permits, give PPV to such patients at least 2 weeks before surgery.

What needle length is recommended for administration of PPV to adults?
Pneumococcal vaccine may be given either IM or SC. Use a 1–1½" needle for IM, depending on muscle mass. For SC, use a 5/8–3/4" needle.

Which patients should also receive the pneumococcal conjugated vaccine (PCV)?
PCV is recommended for all children age less than 24 months as well as children ages 24–59 months with a high-risk medical condition. Consult the ACIP recommendations for more details (MMWR, Vol. 49, RR-9, 10/6/00).