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Pneumococcal polysaccharide vaccine (23-valent) (PPSV23): Drug information

Pneumococcal polysaccharide vaccine (23-valent) (PPSV23): Drug information
(For additional information see "Pneumococcal polysaccharide vaccine (23-valent) (PPSV23): Patient drug information" and see "Pneumococcal polysaccharide vaccine (23-valent) (PPSV23): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Pneumovax 23
Brand Names: Canada
  • Pneumo 23;
  • Pneumovax 23
Pharmacologic Category
  • Vaccine;
  • Vaccine, Inactivated (Bacterial)
Dosing: Adult

Note: According to ACIP, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (Ref).

Pneumococcal disease prevention

Pneumococcal disease prevention:

CDC/ACIP recommendations: PPSV23: IM, SUBQ: 0.5 mL/dose; see the following recommendations based on age, prior pneumococcal vaccination, and comorbid conditions/risk factors (Ref). For additional guidance, the CDC recommends using the PneumoRecs VaxAdvisor (mobile app or web version: https://www2a.cdc.gov/vaccines/m/pneumo/agegroup.html).

Pneumococcal Vaccination for Patients 19 to 64 Years of Age with Certain Chronic Health Conditions or Other Risk Factorsa,b

Prior pneumococcal vaccination

Option Ac

Option Bd

a Includes alcohol use disorder, chronic heart/liver/lung disease, cigarette smoking, diabetes mellitus.

b Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

c PCV20 available.

d PCV15 and PPSV23 available.

e Also applies to patients who previously received PCV7 (at any age) but no other pneumococcal vaccines or unknown vaccination status.

f Review recommendations again when patient turns 65 years of age.

Nonee

PCV20

PCV15 followed by PPSV23 ≥1 year later

PPSV23 only

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only

PCV20 administered ≥1 year later

PPSV23 administered ≥1 year laterf

PCV13 and PPSV23

No additional pneumococcal vaccine at this time.f

PCV15 only

PPSV23 ≥1 year later

PCV20 only

No additional pneumococcal vaccine at this time.

Pneumococcal Vaccination for Patients 19 to 64 Years of Age with Specified Immunocompromising Conditionsa,b

Prior pneumococcal vaccination

Option Ac

Option Bd

a Includes asplenia (congenital or acquired), chronic renal failure, generalized malignancy, HIV infection, Hodgkin disease, immunodeficiencies (congenital or acquired), immunosuppression (iatrogenic, including immunosuppressive therapies), leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease and other hemoglobinopathies, solid organ transplant. Excludes hematopoietic cell transplant (HCT).

b Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

c PCV20 available.

d PCV15 and PPSV23 available.

e Also applies to patients who previously received PCV7 (at any age) but no other pneumococcal vaccines or unknown vaccination status.

f Review recommendations again when patient turns 65 years of age.

Nonee

PCV20

PCV15 followed by PPSV23 ≥8 weeks later

PPSV23 only

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only

PCV20 administered ≥1 year later

PPSV23 administered ≥8 weeks later followed by another PPSV23 dose ≥5 years laterf

PCV13 and 1 dose of PPSV23

PCV20 administered ≥5 years later

PPSV23 administered ≥5 years laterf

PCV13 and 2 doses of PPSV23

PCV20 administered ≥5 years later

No additional pneumococcal vaccine at this timef

PCV15 only

PPSV23 administered ≥8 weeks later

PCV20 only

No additional pneumococcal vaccine at this time.

Pneumococcal Vaccination for Patients 19 to 64 Years of Age with a Cochlear Implant or Cerebrospinal Fluid Leaka

Prior pneumococcal vaccination

Option Ab

Option Bc

a Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

b PCV20 available.

c PCV15 and PPSV23 available.

d Also applies to patients who previously received PCV7 (at any age) but no other pneumococcal vaccines or unknown vaccination status.

e Review recommendations again when patient turns 65 years of age.

Noned

PCV20

PCV15 followed by PPSV23 ≥8 weeks later

PPSV23 only

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only

PCV20 administered ≥1 year later

PPSV23 administered ≥8 weeks latere

PCV13 and 1 dose of PPSV23

PCV20 administered ≥5 years later

No additional pneumococcal vaccine at this timee

PCV15 only

PPSV23 administered ≥8 weeks latere

PCV20 only

No pneumococcal vaccine at this time.

Pneumococcal Vaccination for Patients ≥19 Years of Age after HCTa,b

Prior pneumococcal vaccination

Option Ac

Option Bd

a Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

b Four doses of a pneumococcal vaccine after HCT are needed to complete the series.

c PCV20 available.

d PCV15 and PPSV23 available.

e Whichever time point is later; consult with transplant providers for optimal timing.

None after HCT

Three doses of PCV20 administered 4 weeks apart beginning 3 to 6 months after HCT; administer fourth dose of PCV20 ≥6 months after third dose of PCV20 or ≥1 year from HCTe

Three doses of PCV15 administered 4 weeks apart beginning 3 to 6 months after HCT, followed by PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

1 dose of PCV13 or PCV 15 after HCT

Two doses of PCV20 administered 4 weeks apart beginning 4 weeks after last PCV13 or PCV15 dose;administer third dose of PCV20 ≥6 months after second dose of PCV20 or ≥1 year from HCTe

Two doses of PCV15 administered 4 weeks apart beginning 4 weeks after last PCV13 or PCV15 dose; administer PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

2 doses of PCV13 or PCV 15 after HCT

PCV20 administered 4 weeks after last PCV13 or PCV15 dose; administer second dose of PCV20 ≥6 months after first dose of PCV20 or ≥1 year from HCTe

PCV15 administered 4 weeks after last PCV13 or PCV15 dose, followed by PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

3 doses of PCV13 or PCV 15 after HCT

PCV20 administered ≥6 months after last dose of PCV13 or PCV15 or ≥1 year from HCTe

PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

Canadian recommendations: The Canadian National Advisory Committee on Immunization (NACI) provides different recommendations as compared to the CDC; see NACI recommendations for details.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Pneumococcal disease prevention :

CDC/ACIP recommendations: PPSV23: IM, SUBQ: 0.5 mL/dose; see the following recommendations based on prior pneumococcal vaccination and comorbid conditions/risk factors (Ref). For additional guidance, the CDC recommends using the PneumoRecs VaxAdvisor (mobile app or web version: https://www2a.cdc.gov/vaccines/m/pneumo/agegroup.html).

Pneumococcal Vaccination for Older Adultsa

Prior pneumococcal vaccination

Option Ab

Option Bc

a Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

b PCV20 available.

c PCV15 and PPSV23 available.

d Also applies to patients who previously received PCV7 at any age but no other pneumococcal vaccines.

e Consider shorter interval (minimum of 8 weeks) for those with an immunocompromising condition, cochlear implant, or cerebrospinal fluid (CSF) leak.

f For adults with an immunocompromising condition, cochlear implant, or CSF leak, the minimum interval for PPSV23 is ≥8 weeks since last PCV13 dose and ≥5 years since last PPSV23 dose.

Noned

PCV20

PCV15 followed by PPSV23 ≥1 year latere

PPSV23 only (at any age)

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only (at any age)

PCV20 administered ≥1 year later

PPSV23 administered ≥1 year latere

PCV13 (at any age) and PPSV23 at <65 years of age

PCV20 administered ≥5 years after last pneumococcal vaccination

PPSV23 administered ≥1 year after PCV13 and ≥5 years after last PPSV23f

PCV13 (at any age) and PPSV23 at ≥65 years of age

May administer PCV20 ≥5 years after last pneumococcal vaccine (per shared clinical decision-making).

PCV15 only

PPSV23 administered ≥1 year latere

PCV20 only

No additional pneumococcal vaccine at this time.

Canadian recommendations: The Canadian National Advisory Committee on Immunization (NACI) provides different recommendations as compared to the CDC; see NACI recommendations for details.

Dosing: Pediatric

(For additional information see "Pneumococcal polysaccharide vaccine (23-valent) (PPSV23): Pediatric drug information")

Note: Consult CDC/ACIP annual immunization schedules for additional information including specific detailed recommendations for catch-up scenarios and/or care of patients with high-risk conditions. According to ACIP, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (Ref).

Primary immunization

Primary immunization: Children ≥2 years and Adolescents with specified underlying medical conditions: IM, SubQ: 0.5 mL as a single dose; immunization with pneumococcal conjugate vaccine (PCV13) should be completed prior to pneumococcal polysaccharide vaccine (PPSV23) as recommended. The minimum interval between PCV13 and PPSV23 is 8 weeks (Ref).

Revaccination

Revaccination: Children ≥2 and Adolescents with functional or anatomic asplenia, those who are immunocompromised, and others with high-risk medical conditions [see guidelines for specific details]: One revaccination dose ≥5 years after the first dose of PPSV23.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Local: Erythema at injection site (16% to 35%), induration at injection site (≤40%), local soreness/soreness at injection site (≤77%), pain at injection site (≤77%), swelling at injection site (≤40%; including peripheral edema in injected extremity), tenderness at injection site (≤77%)

Nervous system: Fatigue (≤18%), headache (18%)

Neuromuscular & skeletal: Asthenia (≤18%), myalgia (12% to 17%)

1% to 10%:

Dermatologic: Ecchymoses (1%), pruritus (≤2%)

Gastrointestinal: Diarrhea (1%), dyspepsia (1%), nausea (2%)

Nervous system: Chills (3% to 8%)

Neuromuscular & skeletal: Neck pain (2%)

Respiratory: Upper respiratory tract infection (3%)

Miscellaneous: Fever (1% to 2%)

Postmarketing:

Dermatologic: Cellulitis, erythema multiforme, skin rash, urticaria

Gastrointestinal: Vomiting

Hematologic & oncologic: C-reactive protein increased, hemolytic anemia (in patients with other hematologic disorders), leukocytosis, lymphadenitis, lymphadenopathy, thrombocytopenia (in patients with stabilized immune thrombocytopenia)

Hypersensitivity: Angioedema, nonimmune anaphylaxis, serum sickness

Local: Tissue necrosis at injection site, warm sensation at injection site

Nervous system: Guillain-Barré syndrome, malaise, nerve root disorder, paresthesia

Neuromuscular & skeletal: Arthralgia, arthritis, decreased range of motion (limb)

Miscellaneous: Febrile seizure

Contraindications

Severe allergic reaction (eg, anaphylactic/anaphylactoid reaction) to pneumococcal vaccine or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2023]).

• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinitis) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).

• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2023]).

Disease-related concerns:

• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Postpone administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2023]).

• Bleeding disorders: Use with caution in patients with bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2023]).

• Cardiovascular disease: Use with caution in patients with severely compromised cardiovascular function where a systemic reaction may pose a significant risk.

• HIV: Patients with HIV should be vaccinated as soon as possible following confirmation of the diagnosis (CDC/ACIP 2012).

• Cerebrospinal fluid (CSF) leaks: Vaccination may not be as effective in patients with chronic CSF leaks due to congenital lesions, skull fractures, or neurosurgical procedures.

• Pneumococcal meningitis: Pneumococcal vaccine may not be effective in preventing pneumococcal meningitis in persons who have chronic cerebrospinal fluid leakage resulting from congenital lesions, skull fractures, or neurosurgical procedures.

• Respiratory disease: Use with caution in patients with severe pulmonary disease where a systemic reaction may pose a significant risk.

• Splenectomy: Patients who will undergo splenectomy should also be vaccinated at least 2 weeks prior to surgery, if possible (IDSA [Rubin 2014]).

• Thrombocytopenia purpura: May cause relapse in patients with stable idiopathic thrombocytopenia purpura.

Concurrent drug therapy issues:

• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2023]).

• Vaccines: In order to maximize vaccination rates, the ACIP recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or nonlive) for which a person is eligible at a single visit, unless contraindications exist (ACIP [Kroger 2023]). If a person has not received any pneumococcal vaccine or if pneumococcal vaccination status is unknown, PPSV23 should be administered as indicated.

• Antibiotic prophylaxis: This vaccine does not replace the need for penicillin (or other antibiotic) prophylaxis against pneumococcal infection. In persons who require penicillin (or other antibiotic) prophylaxis against pneumococcal infection, such prophylaxis should not be discontinued after vaccination with pneumococcal vaccine.

Special populations:

• Altered immunocompetence: Postpone vaccination during periods of severe immunosuppression (eg, patients receiving chemo/radiation therapy or other immunosuppressive therapy [including high-dose corticosteroids]) if appropriate; may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines. Nonlive vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; nonlive vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2023]; (IDSA [Rubin 2014]).

• Children: Pneumococcal vaccine is not approved for use in children <2 years. Children in this age group do not develop an effective immune response to the capsular types contained in this polysaccharide vaccine.

• Cochlear implants: Patients who will undergo cochlear implant placement should be vaccinated at least 2 weeks prior to surgery, if possible (IDSA [Rubin 2014]).

• Older adults: Postmarketing reports of adverse effects in elderly patients, especially those with comorbidities, have been significant enough to require hospitalization.

Other warnings/precautions:

• Appropriate use: Use of this vaccine for specific medical and/or other indications (eg, immunocompromising conditions, hepatic or kidney disease, diabetes) is also addressed in the annual ACIP Recommended Immunization Schedules (refer to CDC schedule for detailed information). Specific recommendations for use of this vaccine in immunocompromised patients with asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants, hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ transplant (prior to or after), or those receiving immunosuppressive therapy for chronic conditions are available from the IDSA (Rubin 2014). Vaccination does not replace the need for antibiotic prophylaxis against pneumococcal infection when otherwise required.

• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2023]). One study reported that routine prophylactic administration of acetaminophen prior to vaccination to prevent fever decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).

• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval (ACIP [Kroger 2023]).

Warnings: Additional Pediatric Considerations

Not recommended for use in infants and children <2 years of age.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, solution:

Pneumovax 23: 25 mcg each of 23 capsular polysaccharide isolates/0.5 mL (0.5 mL, 2.5 mL) [contains phenol]

Generic Equivalent Available: US

No

Pricing: US

Injection (Pneumovax 23 Injection)

25 mcg/0.5 mL (per 0.5 mL): $140.50

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

IM, SUBQ: Administer SUBQ or IM (deltoid muscle or lateral midthigh). Do not inject IV; avoid intradermal administration (may cause severe local reactions). Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Ref). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, patients should be vaccinated while seated or lying down (Ref). If purchased under CDC contract, US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.

For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23-gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (Ref).

Administration: Pediatric

Administer SUBQ or IM either the anterolateral aspect of the thigh or the deltoid muscle; not for IV or intradermal administration. If injecting in the deltoid muscle, use proper injection technique (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Ref). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection (Ref). To prevent syncope-related injuries, adolescents should be vaccinated while seated or lying down (Ref). If purchased under CDC contract, US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.

For patients at risk of hemorrhage following intramuscular injection, the vaccine should be administered intramuscularly if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23-gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (Ref).

Medication Guide and/or Vaccine Information Statement (VIS)

In the US, the appropriate CDC-approved Vaccine Information Statement (VIS) should be provided to the patient/caregiver before administering each dose of this vaccine. If purchased under CDC contract, the VIS must be provided and the VIS edition date and date it was provided to the patient/caregiver should be recorded. VIS is available at http://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.html.

Use: Labeled Indications

Pneumococcal disease prevention: Active immunization of children ≥2 years and persons ≥50 years who are at increased risk for pneumococcal disease caused by the 23 serotypes included in the vaccine.

Advisory Committee on Immunization Practices recommendations:

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination in the following persons (ACIP [Kobayashi 2015]; CDC/ACIP [Kobayashi 2023]; CDC/ACIP [Matanock 2019]; CDC/ACIP [Nuorti 2010]):

  • Children ≥2 years of age and adolescents with functional or anatomic asplenia, including sickle cell disease or other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy

  • Immunocompetent children ≥2 years of age and adolescents with chronic heart disease (particularly cyanotic congenital heart disease and heart failure), chronic lung disease (including asthma if treated with high dose corticosteroids), diabetes, cerebrospinal fluid leaks, or cochlear implants

  • Immunocompromised children ≥2 years of age and adolescents with congenital or acquired immunodeficiency (includes B or T cell deficiency, complement deficiencies and phagocytic disorders; excludes chronic granulomatous disease), HIV infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancies, solid organ transplant, multiple myeloma, or other diseases requiring immunosuppressive drugs (including long-term systemic corticosteroids and radiation therapy)

  • Adults 19 to 64 years of age with any of the following underlying medical conditions or risk factors, who received PCV15: alcohol use disorder, chronic heart disease (including heart failure, cardiomyopathies), chronic liver disease, chronic lung disease (including chronic obstructive pulmonary disease, emphysema, asthma), cigarette smoking, diabetes mellitus, cochlear implant, cerebrospinal fluid leaks, immunocompromising conditions (eg, asplenia [congenital or acquired], chronic renal failure, congenital or acquired immunodeficiency [including B- or T-cell deficiency, complement deficiencies and phagocytic disorders; excluding chronic granulomatous disease], malignancy, HIV infection, Hodgkin disease, iatrogenic immunosuppression [including long-term systemic corticosteroids, radiation therapy], leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease or other hemoglobinopathies, solid organ transplant)

  • Adults ≥65 years of age (unless they are vaccinated with PCV20)

Medication Safety Issues
Sound-alike/look-alike issues:

Pneumococcal 23-valent polysaccharide vaccine (Pneumovax 23) may be confused with pneumococcal 13-valent conjugate vaccine (Prevnar 13), pneumococcal 15-valent conjugate vaccine (Vaxneuvance, PCV15), and pneumococcal 20-valent conjugate vaccine (Prevnar 20, PCV20).

PPSV23 (pneumococcal 23-valent polysaccharide vaccine) may be confused with PCV13 (pneumococcal 13-valent conjugate vaccine), PCV15 (pneumococcal 15-valent conjugate vaccine), and PCV20 (pneumococcal 20-valent conjugate vaccine).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification

Anti-CD20 B-Cell Depleting Therapies: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider therapy modification

Corticosteroids (Systemic): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination

Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider therapy modification

Immunosuppressants (Cytotoxic Chemotherapy): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Immunosuppressants (Miscellaneous Oncologic Agents): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Immunosuppressants (Therapeutic Immunosuppressant Agents): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Methotrexate: May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Pneumococcal Conjugate Vaccine (13-Valent): Pneumococcal Polysaccharide Vaccine (23-Valent) may diminish the therapeutic effect of Pneumococcal Conjugate Vaccine (13-Valent). Management: Administer PCV13 prior to administration of PPSV23. Immunocompetent patient with comorbidities: age 24 months to 71 months, separate by 8 weeks; age 65 years or older, separate by 1 year. Immunocompromised patient over age 24 months, separate by 8 weeks. Risk D: Consider therapy modification

Pneumococcal Conjugate Vaccine (20-Valent): Pneumococcal Polysaccharide Vaccine (23-Valent) may diminish the therapeutic effect of Pneumococcal Conjugate Vaccine (20-Valent). Risk C: Monitor therapy

Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification

Siponimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Avoid administration of vaccines (inactivated) during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider therapy modification

Teplizumab: May diminish the therapeutic effect of Pneumococcal Vaccines. Management: Vaccination with inactivated vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during therapy, or for 6 weeks after completion of therapy. See full mono for recommendations for number, order, and timing of vaccines. Risk D: Consider therapy modification

Teplizumab: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccination with inactivated or non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider therapy modification

Zoster Vaccine (Live/Attenuated): Pneumococcal Polysaccharide Vaccine (23-Valent) may diminish the therapeutic effect of Zoster Vaccine (Live/Attenuated). Risk C: Monitor therapy

Pregnancy Considerations

Antibodies generated following PPSV23 vaccination of pregnant patients can be detected in cord blood (CDC/ACIP [Kobayashi 2023]).

Nonlive bacterial vaccines have not been shown to cause increased risks to the fetus (ACIP [Kroger 2023]). An increased risk of adverse pregnancy outcomes has not been observed following PPSV23 vaccination (CDC/ACIP [Kobayashi 2023]).

The immune response generated by the PPSV23 vaccine in pregnant patients is comparable to the immune response in patients who are not pregnant. Although specific recommendations for vaccination of pregnant patients is not available (CDC/ACIP [Kobayashi 2023]), pneumococcal vaccines may be administered during pregnancy in persons at increased risk of severe disease due to underlying medical conditions (ACOG 2018; ACOG 2022).

Breastfeeding Considerations

It is not known if the components of this vaccine are present in breast milk.

According to the manufacturer, the decision to continue or discontinue breastfeeding following immunization should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of vaccination to the mother. Nonlive vaccines have not been shown to affect the safety of the breastfed infant or mother. Breastfeeding infants should be vaccinated according to the recommended schedules (ACIP [Kroger 2023]).

Monitoring Parameters

Monitor for hypersensitivity and syncope for 15 minutes following administration (ACIP [Kroger 2023]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.

Mechanism of Action

Pneumococcal polysaccharide polyvalent is an inactive bacterial vaccine that induces active immunization to the serotypes contained in the vaccine. Although there are more than 90 known pneumococcal capsular types, pneumococcal disease is mainly caused by only a few serotypes of pneumococci. Pneumococcal vaccine polyvalent contains capsular polysaccharides of 23 pneumococcal types of Streptococcus pneumoniae that represent at least 85% to 90% of pneumococcal disease isolates in the US. The 23 capsular pneumococcal vaccine contains purified capsular polysaccharides of pneumococcal types 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F.

Efficacy: In adults, PPSV23 demonstrated 50% to 80% efficacy in preventing invasive pneumococcal disease due to relevant serotypes of S. pneumoniae (CDC/ACIP 59[34] 2010).

Pharmacokinetics (Adult Data Unless Noted)

Onset: Immunity develops within approximately 2 to 3 weeks after vaccination (Pink Book [Atkinson 2012]).

Duration: Protective antibody levels persist for at least 5 years. A more rapid decline may occur in some groups (eg, children, elderly) (Pink Book [Atkinson 2012]).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AU) Australia: Pneumovax 23 polyvalent;
  • (DE) Germany: Pneumorix;
  • (FR) France: Pneumovax;
  • (IE) Ireland: Pneumovax ii;
  • (NZ) New Zealand: Pneumovax;
  • (PT) Portugal: Pneumovax;
  • (QA) Qatar: Pneumovax 23;
  • (RU) Russian Federation: Pneumo 23;
  • (TR) Turkey: Pnu imune 23;
  • (VE) Venezuela, Bolivarian Republic of: Pneumovax
  1. American Academy of Pediatrics Committee on Infectious Diseases, "Recommendations for the Prevention of Streptococcus pneumoniae Infections in Infants and Children: Use of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Pneumococcal Polysaccharide Vaccine (PPSV23)," Pediatrics, 2010, 126(1):186-90. [PubMed 20498180]
  2. American College of Obstetricians and Gynecologists (ACOG). Committee Opinion no. 741: maternal immunization. Obstet Gynecol. 2018;131(6):e214-e217. doi:10.1097/AOG.0000000000002662 [PubMed 29794683]
  3. American College of Obstetricians and Gynecologists (ACOG). Maternal immunization practice advisory. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/10/maternal-immunization. Updated October 2022. Accessed December 13, 2022.
  4. Atkinson W, Wolfe C, Hamborsky J, eds. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 12th ed, second printing. Washington, DC: Public Health Foundation; 2012.
  5. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59(34):1102-1106. [PubMed 20814406]
  6. Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61(40):816-819. [PubMed 23051612]
  7. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm. Updated October 12, 2012. Accessed August 27, 2013.
  8. Centers for Disease Control and Prevention (CDC). Pneumococcal Vaccination. https://www.cdc.gov/pneumococcal/vaccination.html. Updated January 20, 2023. Accessed June 8, 2023.
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  10. Davidson M, Bulkow LR, Grabman J, et al, “Immunogenicity of Pneumococcal Revaccination in Patients With Chronic Disease,” Arch Intern Med, 1994, 154(19):2209-14. [PubMed 7944842]
  11. Foster SL, Davis MV. Vaccine administration: preventing serious shoulder injuries. J Am Pharm Assoc (2003). 2013;53(1):102‐103. doi:10.1331/JAPhA.2013.13503 [PubMed 23636163]
  12. Kim DK, Riley LE, Harriman KH, Hunter P, Bridges CB. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66(5):136-138. [PubMed 28182599]
  13. Kobayashi M, Bennett NM, Gierke R, et al. Intervals between PCV13 and PPSV23 vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2015;64(34):944-947. [PubMed 26334788]
  14. Kobayashi M, Pilishvil T, Gierke R, et al. Pneumococcal vaccine for adults aged ≥ 19 years: recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(3):1-39. doi:10.15585/mmwr.rr7203a1 [PubMed 37669242]
  15. Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization: best practices guidance of the Advisory Committee on Immunization Practices (ACIP). https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. Accessed June 8, 2023.
  16. Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: updated recommendations of the Advisory Committee on Immunization Practices [published correction appears in MMWR Morb Mortal Wkly Rep. 2020;68(5152):1195]. MMWR Morb Mortal Wkly Rep. 2019;68(46):1069-1075. doi:10.15585/mmwr.mm6846a5. [PubMed 31751323]
  17. Nuorti JP, Whitney CG; Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease among infants and children: use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-11):1-18. [PubMed 21150868]
  18. Pneumovax 23 (pneumococcal vaccine polyvalent) [prescribing information]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; April 2021.
  19. Pneumovax 23 (pneumococcal vaccine polyvalent) [prescribing information]. Rahway, NJ: Merck Sharp & Dohme LLC; April 2023.
  20. Pneumovax 23 (pneumococcal vaccine polyvalent) [prescribing information]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; September 2020.
  21. Prymula R, Siegrist CA, Chlibek R, et al, “Effect of Prophylactic Paracetamol Administration at Time of Vaccination on Febrile Reactions and Antibody Responses in Children: Two Open-Label, Randomised Controlled Trials,” Lancet, 2009, 374(9698):1339-50. [PubMed 19837254]
  22. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):e44-e100. [PubMed 24311479]
  23. Tomczyk S, Bennett NM, Stoecker C, et al; Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63(37):822-825. [PubMed 25233284]
  24. World Health Organization (WHO). Guiding principles for immunization activities during the COVID-19 pandemic: interim guidance, 26 March 2020. Published March 26, 2020. Available at https://apps.who.int/iris/handle/10665/331590
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