Low risk attached to second pneumococcal vaccination
Low risk attached to second pneumococcal vaccination
Study shows side effects are minor and temporary
It might bring some discomfort, but the elderly and others at risk should get a second vaccination for pneumococcal infections five years after the first.
Side effects from revaccinations are relatively mild and short-lived, with participants mainly reporting sore arms and redness at the injection site, according to a study from the Center for Health Studies/Group Health Cooperative of Puget Sound in Seattle.
While those side effects may cause some temporary discomfort, the Centers for Disease Control and Prevention in Atlanta says the lives saved by pneumococcal vaccine are well worth the nuisance, especially in view of the outbreak of drug-resistant pneumococcal disease in adults in Oklahoma three years ago.
Yet the numbers of primary and revaccinations remain low, about 45% of all people over 65 and those who display a variety of risks because they have a chronic disease or a compromised immune system.
"Probably physicians haven’t gotten the word," says the study’s lead author, Lisa Jackson, MD, MPH, assistant investigator at the Group Health Cooperative. "There were a lot of anecdotal reports and there was a myth circulating way back when about side effects from revaccinations."
Antibody levels decline over time
Jackson says her study published in the Journal of the American Medical Association should reassure health care providers the revaccination is safe and even essential because antibody levels decline over time.
"No serious or unexpected adverse events associated with vaccination were identified," the study says, although 3% of those who received the pneumococcal polysaccharide vaccine for the first time reported a reaction and 11% of those revaccinated reported a reaction.
"Given the burden of the disease, revaccination is warranted," says Scott Dowell, MD, a medical epidemiologist in the CDC’s respiratory disease branch.
However, Dowell says he is concerned about the size of the reactions as large as 10.2 cm or 4 inches in diameter in some patients. He urged doctors to warn their patients of the possibility of what he considers severe swelling.
"I think of a red spot that big on the arm of a thin elderly woman is significant," he says.
Jackson’s study included 1,420 patients between the ages of 65 and 74 or between 50 and 64 with at least one chronic medical condition for which pneumococcal vaccination is recommended (see box, p. 46).
Some participants have not been vaccinated and some were given a second vaccination at least five years after the first if they reported no adverse reaction from the first innoculation. Researchers compared postvaccination effects of those receiving a primary vaccination to those with a second dose.
Participants identified through the health center’s computerized vaccination database were injected with 23-valent pneumococcal vaccine intramuscularly in the left deltoid during an enrollment visit.
They were given a study diary and a supply of single-use thermometers with instructions to record their oral temperatures the evening of the vaccination and every morning and evening for the following six days. They were asked to report systemic symptoms and local reactions for 13 days after vaccination and were given a measuring tool for any redness or swelling that might occur.
Three participants sought medical care for side effects, one for swelling and redness at the injection site and two who developed minor rashes.
Jackson’s team reports 84 patients experienced a "sizeable" adverse reaction of swelling or redness at least 10.2 cm (4 inches).
Twelve percent reported severe limitation of arm movement and 18% experienced severe arm soreness within two days of vaccination.
Jackson says she recognizes some patients might be "somewhat reluctant" to be revaccinated, but the risk is so small that health care practitioners should be reassured, even if a patient is accidentally revaccinated earlier than five years after the primary vaccination.
Vaccine effectiveness will improve
Recent studies show pneumococcal vaccine is about 56% effective, Dowell says, but that’s an acceptable success rate — for now.
Dowell expects the effectiveness of the pneumococcal vaccine will be vastly improved in the next few years as scientists perfect the bonding of protein with the polysaccharide in the vaccine.
It is almost impossible to determine how effective pneumococcal vaccine is against pneumonia, says Jackson, because there are so many potential causes for pneumonia. However, bloodstream infections are relatively easy to identify and the good results achieved with the vaccine "can be extrapolated to the probable causes of pneumonia as well."
Lisa Jackson can be reached at (206) 790-0734; Scott Dowell can be reached at (404) 639-4646.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.