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Safety of revaccination with pneumococcal polysaccharide vaccine. 1999

L A Jackson, and P Benson, and V P Sneller, and J C Butler, and R S Thompson, and R T Chen, and L S Lewis, and G Carlone, and F DeStefano, and P Holder, and T Lezhava, and W W Williams
Immunization Studies Program, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA. lajack@u.washington.edu

BACKGROUND Revaccination of healthy adults with pneumococcal polysaccharide vaccine (PPV) within several years of first vaccination has been associated with a higher than expected frequency and severity of local injection site reactions. The risk of adverse events associated with revaccination of elderly and chronically ill persons 5 or more years after first vaccination, as is currently recommended, has not been well defined. OBJECTIVE To determine whether revaccination with PPV at least 5 years after first vaccination is associated with more frequent or more serious adverse events than those following first vaccination. METHODS Comparative intervention study conducted between April 1996 and August 1997. METHODS Persons aged 50 to 74 years either who had never been vaccinated with PPV (n = 901) or who had been vaccinated once at least 5 years prior to enrollment (n = 513). METHODS PPV vaccination. METHODS Postvaccination local injection site reactions and prevaccination concentrations of type-specific antibodies. RESULTS Those who were revaccinated 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: 11% (55/513) vs 3% (29/901) (relative risk [RR], 3.3; 95% confidence interval [CI], 2.1-5.1). These reactions resolved by a median of 3 days following vaccination. The highest rate was among revaccinated patients who were immunocompetent and did not have chronic illness: 15% (33/228) compared with 3% (10/337) among comparable patients receiving their first vaccinations (RR, 4.9; 95% CI, 2.4-9.7). The risk of these local reactions was significantly correlated with prevaccination geometric mean antibody concentrations. CONCLUSIONS Physicians and patients should be aware that self-limited local injection site reactions occur more frequently following revaccination compared with first vaccination; however, this risk does not represent a contraindication to revaccination with PPV for recommended groups.

UI MeSH Term Description Entries
D007115 Immunization Schedule Schedule giving optimum times usually for primary and/or secondary immunization. Immunization Schedules,Schedule, Immunization,Schedules, Immunization
D007121 Immunocompetence The ability of lymphoid cells to mount a humoral or cellular immune response when challenged by antigen. Competence, Immunologic,Immunologic Competence,Immunological Competence,Competence, Immunological
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000907 Antibodies, Bacterial Immunoglobulins produced in a response to BACTERIAL ANTIGENS. Bacterial Antibodies
D001428 Bacterial Vaccines Suspensions of attenuated or killed bacteria administered for the prevention or treatment of infectious bacterial disease. Bacterial Vaccine,Bacterin,Vaccine, Bacterial,Vaccines, Bacterial
D013296 Streptococcus pneumoniae A gram-positive organism found in the upper respiratory tract, inflammatory exudates, and various body fluids of normal and/or diseased humans and, rarely, domestic animals. Diplococcus pneumoniae,Pneumococcus

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