Clinical Inquiries

Which asthma patients should get the pneumococcal vaccine?

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References

Impact of vaccine on invasive disease in younger asthma patients?

A retrospective, nested, case-controlled study examined the relationship between asthma and invasive pneumococcal disease (IPD) in 6985 patients enrolled in Tennessee’s Medicaid program.3 Patients 2 to 49 years of age with any IPD diagnosis were identified using International Classification of Diseases (ICD-9-CM) codes and followed for 8 years.

Asthma patients without coexisting conditions that confer a high risk of IPD (such as diabetes, cardiac disease, and infection with human immunodeficiency virus) had a 14.7% risk of IPD compared with a risk of only 7.4% in age-matched controls (adjusted odds ratio=2.4; 95% CI, 1.7-3.4). The authors concluded that this Medicaid population with asthma had an increased incidence of IPD of 1 to 3 cases annually per 10,000 people. The effect of pneumococcal vaccination on the incidence of IPD in these younger asthma patients is unknown, however.3

Recommendations

The National Asthma Education and Prevention Program (NAEPP)4 and the Global Initiative for Asthma (GINA)5 make no recommendations regarding the administration of the pneumococcal vaccine.

The Advisory Committee on Immunization Practices (ACIP) recommends vaccination for all adults 65 years and older and adults 19 years and older with chronic lung disease, including asthma, or other chronic medical conditions such as cardiovascular diseases, diabetes, chronic liver diseases, chronic alcoholism, chronic renal failure, asplenia, and other immunocompromising conditions.6

The British Department of Health recommends vaccination with either the 7-valent conjugate or the 23-valent polysaccharide pneumococcal vaccine for all asthma patients taking systemic steroids longer than 1 month at a dose equivalent to prednisolone 20 mg daily and for children weighing less than 20 kg who take daily steroids at a dose of ≥1 mg/kg. Efficacy studies aren’t available to support this recommendation.7

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