Flu Vaccination

Pneumococcal Disease Complicating Influenza¹

Influenza predisposes individuals to developing bacterial CAP. During each of the influenza pandemics of the 20th century, secondary bacterial pneumonia was a frequent cause of illness and death, and S. pneumoniae (pneumococcus) was reported as the most common aetiology. These findings also apply to seasonal influenza.

S. pneumoniae remains a leading cause of vaccine-preventable illness and death in the United States. Recently, pneumococcal infections have been identified as an important complication in severe and fatal cases of 2009 H1N1 influenza virus infection. Importantly, however, approximately 70 million persons with existing PPSV indications (Table) are unvaccinated (National Health Interview Survey, 2007).

Use of PPSV During the 2009 H1N1 Influenza Pandemic¹

CDC’s ACIP recommends a single dose of PPSV for all people ≥65 years of age and for persons 2 through 64 years of age with certain high-risk conditions. Most people in these groups are at increased risk of pneumococcal disease as well as serious complications from influenza virus infections. Single revaccination at least 5 years after the initial vaccination is recommended for people ≥65 years who were first vaccinated before the age of 65 years. Single revaccination is also recommended for people at the highest risk of disease, such as those who have functional and anatomical asplenia, and those who have an HIV infection, AIDS or malignancy and have at least 5 years elapsed from receipt of first vaccination. All people who have existing indications for PPSV should continue to be vaccinated according to the current ACIP recommendations during the 2009 H1N1 influenza pandemic. Special emphasis should be placed on vaccinating people 2 through 64 years of age who have established high-risk conditions for pneumococcal disease; PPSV coverage among this group is low, and this group may be more likely to develop secondary bacterial pneumonia after an influenza infection. Use of PPSV among people without current indications for vaccination is not recommended at this time.

Simultaneous Administration of Pneumococcal (PPSV) and Influenza Vaccines

Pneumococcal vaccine can be given at any time during the year and may be given at the same time as the influenza vaccine. Visits for seasonal and 2009 H1N1 influenza vaccination provide a convenient time to evaluate patients for the need for pneumococcal vaccination. Persons who cannot remember if they have ever had the pneumococcal vaccine should still be vaccinated.

US ACIP Recommendations for the Use of PPSV

ACIP, Advisory Committee on Immunization Practices; AIDS, acquired immunodeficiency syndrome; CAP, community-acquired pneumonia; CDC,Centers for Disease Control and Prevention; HIV, human immunodeficiency virus; PPSV, pneumococcal polysaccharide vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine.

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