Revaccination pneumococcal polysaccharide vaccine

Revaccination with the 23-valent pneumococcal polysaccharide vaccine is recommended for adults over the age of 65 years if the first dose was administered when they were less than 65 years... 

A single revaccination should be given if 5 or more years have passed since the first dose in persons older than 10 years. In those who are 10 years or younger, revaccination should be given 3 years after the previous dose. Because children younger than 2 years of age do not respond adequately to the pneumococcal polysaccharide vaccine, a heptavalent pneumococcal conjugate vaccine was created that can be administered at 2, 4, and 6 months of age and between 12 and 15 months of age. 

The question of whether revaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) at least 5 years after the first vaccination is associated with more frequent or more serious adverse events than those after the first vaccination has been studied in patients aged 50-74 years who had never been vaccinated with PPV (n = 901) or who had been vaccinated once at least 5 years before enrolment (n = 513) (8). After one dose of PPV, local injection site reactions and prevaccination concentrations of type-specific antibodies were measured. Those who were re-vaccinated were more likely than those who received their first vaccinations to report a local injection site reaction of at least 10.2 cm (4 in.) in diameter within 2 days of vaccination (55/513 versus 29/ 901, or 11 versus 3%). The reactions resolved by a median of 3 days after vaccination. The highest rate was among revaccinated patients who were immune competent and did not have chronic illnesses 15% (33/228) compared with 3% (10/337) among comparable patients receiving their first vaccinations. The risk of these local reactions correlated significantly with prevaccination geometric mean antibody concentrations. The authors concluded that physicians and patients should be aware that selflimited local injection site reactions occur more often after revaccination compared with a first vaccination however, this risk does not represent a contraindication to revaccination with PPV in recommended patients. 

Jackson LA, Benson P, Sneller VP, Butler JC, Thompson RS, Chen RT, Lewis LS, Carlone G, DeStefano F, Holder P, Lezhava T, Williams WW. Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA 1999 281(3) 243-8. 

Routine revaccination of immunocompetent persons previously vaccinated with 23-valent polysaccharide vaccine is not recommended. However, revaccination once is recommended for persons at least 2 years old who are at highest risk for serious pneumococcal infection and those who are likely to have a rapid decline in pneumococcal antibody levels, provided that 5 or more years have elapsed since receipt of the first dose of pneumococcal vaccine. Revaccination 3 years after the previous dose may be considered for children at highest risk for severe pneumococcal infection who would be 10 years old or younger at the time of revaccination. These children include those with functional or anatomical asplenia (e.g., sickle cell disease or splenectomy) and those with conditions associated with rapid antibody decline after initial vaccination (e.g.. 

Hilleman MR, Carlson AJ, McLean AA, Vella PP, Weibel RE, Woodhour AF. Streptococcus pneumoniae polysaccharide vaccine age and dose responses, safety, persistence of antibody, revaccination, and simultaneous administration of pneumococcal and influenza vaccines. Rev Infect Dis 1981 3(suppl) S31-S42. 

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