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November 2008
Vol. 18 No. 11
Patient Care and Science
ACIP Recommends Pneumococcal Vaccine for Cigarette Smokers

The federal Advisory Committee for Immunization Practices (ACIP) has added cigarette smokers ages 19-64 years to the list of people for whom pneumococcal vaccine is recommended, according to Samuel Katz, MD, FIDSA, IDSA’s liaison to ACIP.

This is the first time ACIP has recommended a vaccine specifically for smokers. The group also recommended that smokers undergo stop-smoking counseling. ACIP made the recommendation at its Oct. 22-23 meeting.

The Centers for Disease Control and Prevention (CDC) estimates that about one-fifth of U.S. adults smoke cigarettes. Cigarette smoking has bee identified as a major risk factor for pneumococcal disease, and the risk of pneumococcal disease increases with the longer one smokes and the number of cigarettes one has smoked. Population-based surveillance studies consistently report that smokers account for approximately half of otherwise healthy adults with invasive pneumococcal disease.

In June ACIP had recommended adding asthma to the list of indictions for giving the vaccine. ACIP may re-evaluate its recommendations in the future as new pneumococcal vaccines are licensed by the Food and Drug Administration (FDA).

Wyeth hopes to have approval for its new pneumococcal conjugate vaccine with 13 serotypes by mid-2009. In addition to the seven serotypes in the current conjugate vaccine, the new vaccine will have six new ones (1, 3, 5, 6A, 7F, 19A). Serotype 19A is of special note as it has become recognized more frequently in some locations and as a cause of invasive disease.

In other news, ACIP:

  • Reviewed safety data on the new human papillomavirus (HPV) vaccine. More than 16 million doses of HPV vaccine have been distributed in the U.S. Syncope continues to be frequent among recipients, but investigations do not show any increased risk for thromboembolism, transverse myelitis, Guillain-Barre syndrome, or other adverse outcomes. As with all approved vaccines, CDC and FDA continue to monitor the safety.
  • Examined changes in rotavirus activity. Following widespread use of a new rotavirus vaccine, the 2007-2008 started 15 weeks later and was 12 weeks shorter than usual.
  • Reviewed safety data on the combined live measles, mumps, rubella, and varicella virus vaccine (MMRV).  Preliminary results have shown a 2-fold higher risk of febrile seizures during the two weeks after vaccination with MMRV, compared with simultaneous separate injections of measles, mumps, rubella (MMR) and varicella vaccines administered at the same visit. In June, ACIP withdrew its preference for combined MMRV over separate injections of MMR and varicella vaccines for the first dose and is awaiting further data on the second dose. However, since MMRV is not currently being distributed in the U.S. because of production problems, the issue is moot.
  • Received an update on influenza vaccine and antivirals. Virus isolates from the southern hemisphere demonstrate good matches with the 2008-2009 vaccine under current use. Increasing reports of H1N1 isolates resistant to oseltamivir range from 4 percent in Spain to 67 percent in Norway.

ACIP recommendations become official once approved by the Centers for Disease Control and Prevention and published in Morbidity and Mortality Weekly Report. For more information, see: http://www.cdc.gov/vaccines/recs/acip/.

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