This presentation has been created and paid for by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
The information in this presentation is intended for health care professionals in the United States, its territories, and Puerto Rico.
Dr. Hsu: Hello and welcome to the “Time to…” Merck video series. I am Dr. Hsu and I’m an internal medicine, infectious diseases and preventive medicine physician at AdventHealth Medical Group in Orlando, Florida.
In this segment, we will discuss the CDC recommendations for pneumococcal disease in adults under age 65 with certain chronic conditions.
Pneumococcal disease, caused by Streptococcus pneumoniae bacteria, has various manifestations, which can be grouped into noninvasive disease when confined to a mucosal location, or invasive disease, when the bacteria are detected in normally sterile sites, such as the blood. Pneumococcal pneumonia can be noninvasive; for example, when isolated to the lungs, or invasive, such as pneumonia with bacteremia.
Following person-to-person transmission via respiratory droplets, the bacteria can remain within the nasopharynx, colonizing and causing no symptoms, or spread to other organs such as the lungs to cause bacteremic pneumococcal pneumonia.
Importantly, S. pneumoniae has the potential to cause other serious manifestations, such as pneumococcal bacteremia, by entering the bloodstream, or crossing the blood-brain barrier to cause pneumococcal meningitis.
In a retrospective cohort study, the risk for invasive pneumococcal disease, or IPD, increased with age, most notably in healthy adults ages 65 years and older.
However, the average rate for IPD was approximately 3- to 7-fold higher in adults younger than age 65 years with diabetes, chronic heart disease, or chronic lung disease, such as COPD, respectively, than in age-matched healthy adults.
Adults with these conditions may have increased susceptibility to pneumococcal disease because of underlying factors related to their chronic condition.
For example, in adults with diabetes, hyperglycemia causes functional impairment of certain immune cells, which results in reduced clearance of bacteria, such as S. pneumoniae, increasing the patient’s risk for infection.
In adults with chronic heart disease, the heart’s diminished capacity to pump blood causes lung congestion.
This accumulation of fluid in the lungs may reduce clearance of bacteria and increase the patient’s risk for infection.
And in adults with COPD, impaired activity of macrophages contributes to chronic inflammation and reduced clearance of bacteria, thus increasing the risk for infection.
Let’s discuss indications and Select Safety Information for PNEUMOVAX 23.
(Voiceover): PNEUMOVAX 23 is a vaccine indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine.
PNEUMOVAX 23 is approved for use in persons 50 years of age or older and persons aged ≥2 years who are at increased risk for pneumococcal disease.
PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine.
Now, let’s discuss some Select Safety Information for PNEUMOVAX 23, which you’ll hear more of throughout this video.
Do not administer PNEUMOVAX 23 to individuals with a history of a hypersensitivity reaction to any component of the vaccine.
Defer vaccination with PNEUMOVAX 23 in persons with moderate or severe acute illness.
Use caution and appropriate care in administering PNEUMOVAX 23 to individuals with severely compromised cardiovascular and/or pulmonary function in whom a systemic reaction would pose a significant risk.
Dr. Hsu: Since 1997, the CDC has specifically recommended vaccination with PNEUMOVAX 23 at the time of diagnosis for appropriate adults under age 65 with diabetes, chronic heart disease, or COPD because of their increased risk for pneumococcal disease.
Therefore, for patients who have just been diagnosed with one of these conditions, pneumococcal vaccination should be considered as part of their routine medical care.
Other medical societies, such as the American Diabetes Association, the American College of Cardiology, and the Global Initiative for Chronic Obstructive Lung Disease, are consistent with the CDC’s recommendation of vaccination with PNEUMOVAX 23 for appropriate adults under age 65 with certain chronic conditions, such as diabetes, chronic heart disease, and COPD.
(Voiceover): Here is some additional safety information for PNEUMOVAX 23.
Available human data from clinical trials of PNEUMOVAX 23 in pregnancy have not established the presence or absence of a vaccine-associated risk.
Dr. Hsu: Despite recommendations for pneumococcal vaccination, vaccination rates in adults at increased risk are low.
For example, the Healthy People 2020 goal for pneumococcal vaccination in adults under age 65 and at increased risk for pneumococcal disease per the ACIP’s definition is 60%.
However, in a 2016 study of patients under age 65 with certain chronic conditions, total vaccination rates were approximately 13% in patients with chronic heart disease, 17% in patients with COPD, and 21% in patients with diabetes after 5 years of follow-up.
(Voiceover): Let’s again discuss some safety information for PNEUMOVAX 23.
Persons who are immunocompromised, including persons receiving immunosuppressive therapy, may have a diminished immune response to PNEUMOVAX 23.
PNEUMOVAX 23 may not be effective in preventing pneumococcal meningitis in patients who have chronic cerebrospinal fluid (CSF) leakage resulting from congenital lesions, skull fractures, or neurosurgical procedures.
Dr. Hsu: Additionally, a 2019 survey conducted by the National Foundation for Infectious Diseases including participants at increased risk for pneumococcal disease showed nearly half were unfamiliar with pneumococcal disease, and nearly 60% with an increased risk had never been advised to get vaccinated.
(Voiceover): Let’s take a moment to review more safety information for PNEUMOVAX 23.
The most common adverse reactions, reported in >10% of subjects vaccinated with PNEUMOVAX 23 in clinical trials, were: injection-site pain/soreness/tenderness, injection-site swelling/induration, headache, injection-site erythema, asthenia and fatigue, and myalgia.
Vaccination with PNEUMOVAX 23 may not offer 100% protection from pneumococcal infection.
Dr. Hsu: As their health care professional, patients want to hear about pneumococcal vaccination from you. Therefore, it’s important that you review benefits and risks, and then provide a strong recommendation to your patients.
In addition, you may also want to consider communicating why you are recommending pneumococcal vaccination for your patient, such as why their condition puts them at increased risk.
PNEUMOVAX 23 is the only pneumococcal vaccine recommended by the CDC for immunocompetent adults under age 65 with diabetes, chronic heart disease, and COPD and should be administered at the time of diagnosis.
The time to implement CDC guidance is now. It is important to help protect your appropriate adult patients against pneumococcal disease.
(Voiceover): Before administering PNEUMOVAX®23, Pneumococcal Vaccine Polyvalent, please read the accompanying Prescribing Information. The Patient Information also is available.
Copyright © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
All rights reserved. US-PNX-01400 07/20
References
1. Cilloniz C et al. Curr Opin Infect Dis. 2016;29(2):187-196.
2. Ludwig E et al. Eur Respir Rev. 2012;21(123):57-65.
3. Henriques-Normark B, Tuonamen El. Cold Spring Harb Perspect Med. 2013;3(7):aO1O215.
4. Shea KM et al. Open Forum Infect Dis. Spring 2014;1:1-9.
5. Boyanova L, Mitova l. Expert Rev Anti Infect Ther. 2013;11:411-420.
6. Chase SC et al. J Card Fail. 2017;23(9):690-696.
7. Mor A et al. Eur J Intern Med. 2013;24:349-353.
8. Barnes PJ et al. PRIMER. 2015;1:1-21.
9. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 1997:46:1-18.
10. CDC. MMWR Morb Mortal Wkly Rep. 2012:61:816-819.
11. American Diabetes Association. Diabetes Care. 2017;40(suppl 1):S1-S135.
12. Amsterdam E et al. J Am Coll Cardiology. 2014;84:e139-e228.
13. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Updated 2019. goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed March 3, 2020.
14. Healthy People 2020. Immunization and Infectious Diseases Data Details. healthypeople.gov/node/3527/data-details. Accessed March 3, 2020.
15. Petigara T, Zhang D. Am J Prev Med. 2018;54(5):630-636.
16. National Foundation for Infectious Diseases. National Poll: Attitudes About Flu and Pneumococcal Disease Prevention.
nfid.org/national-poll-attitudes-about-flu-and-pneumococcal-disease-prevention/. Accessed March 3, 2020.
