A new
23-valent vaccine to protect against
pneumococcal infection has been developed to replace the previous 14-valent
vaccine. The new
vaccine contains
antigens to pneumococcal types that are responsible for approximately 85% of bacteremic
pneumococcal pneumonia. The
vaccine is safe and approximately 70% effective in immunocompetent adults. Immunocompetent persons at high risk for
pneumococcal pneumonia (those with underlying conditions that have been shown to place the patient at increased risk of
infection or at increased risk of death if infected) should receive
pneumococcal vaccine. Moreover, it is recommended that physicians offer the
vaccine to elderly patients without underlying disease. Patients with immune deficiency may be offered the
vaccine, but may not respond to it. Revaccination of patients who received the previous 14-valent
vaccine may be appropriate in selected persons in whom the benefits of revaccination exceed the increased risks of local and systemic reactions. Routine revaccination is not recommended. Although routine use of the
vaccine is not recommended in pregnancy, its use may be appropriate in selected high-risks patients. Physicians appear to be underusing this
vaccine. More attention should be devoted to strategies and programs that facilitate vaccination of patients who can be expected to benefit from the
vaccine.