HIV and ID Observations

From the FDA (and thanks to Physician’s First Watch for reporting the news):

Prevnar 13, a pneumococcal 13-valent conjugate vaccine, was approved today by the U.S. Food and Drug Administration for people ages 50 years and older to prevent pneumonia and invasive disease caused by the bacterium, Streptococcus pneumoniae.

As shown in multiple studies, Prevnar has dramatically lowered the incidence of pneumococcal disease, both in immunized children and also non-immunized children and adults through “herd immunity.” The shift to infections with non-Prevnar covered serotypes has been of some concern, but clearly this vaccine has had a major beneficial effect — something harder to prove with the older, less immunogenic polysaccharide vaccine.

So should we use start using Prevnar in adults?

When I have difficult vaccination questions, I turn to several reliable sources:

• My wife — pediatricians must give 100X (or more) vaccines than adult doctors
• The Immunization Action Coalition, especially their “Ask the Experts” section
• Howard Heller, my friend, ID Colleague, and Chief of Medicine at MIT Health Services, and adult immunization clinical expert

Howard kindly responded to my query this morning, and here’s his take:

We should still use the 23-valent pneumococcal vaccine (Pneumovax, PPS23) for adults until and unless the ACIP changes their recommendations. Although the conjugated vaccine induces higher antibody levels it has not yet been shown to decrease incidence of pneumonia, invasive disease or death. That study is underway. They will also be reviewing the data on the effect that Prevnar-13 in children has had on herd immunity and the prevalence of the various serotypes in invasive pneumococcal disease in adults. The advantage of the 23-valent vaccine is that it covers 10 serotypes that are not covered by PCV13. Stay tuned.

Thank you for that curbside, Howard — let me know if you have any questions about antiretroviral therapy!