성인 폐렴구균 백신에 대한 개정된 권고 (United States, 2022)

Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

성인 폐렴구균 백신에 대한 개정된 권고

폐렴구균 백신에 대한 적응증이 있는 모든 성인에게

다른 백신들보다는 프리베나20 (PCV20)을 제안합니다.

일부 전문가들은 면역저하 또는 뇌수막염 위험이 있는 환자에게 프리베나20 접종 8주 이후에 다당백신 (PPSV23) 투약을 선호합니다.

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2022년 초, ACIP는 폐렴구균 백신에 대한 내용을 개정했습니다.

1) 새로운 백신인 프리베나20 (PCV20)을 접종하거나

2) PCV15 접종 1년 이후에 PPSV23을 접종하는 것입니다. 면역저하, 인공와우 이식, 뇌척수액 누출과 같은 고위험 환자에서는 보호 효과를 빨리 최대화시키기 위해 더 짧은 간격 (8주 이상)의 PPSV23 접종이 필요합니다.

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편리함 측면에서 폐렴구균 예방접종 적응증에 해당하는 모든 성인에게 프리베나20을 제안합니다. 일부 전문가들은 면역저하 또는 뇌수막염 위험이 있는 환자에게 프리베나20 접종 8주 이후에 다당백신 (PPSV23) 투약을 선호하지만 이것은 일부 전문가가 제안하는 것이지 ACIP가 권고하는 내용은 아닙니다.

프리베나20에 대한 기사

http://www.bosa.co.kr/news/articleView.html?idxno=2170937

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http://www.newsmp.com/news/articleView.html?idxno=221355

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Indications for pneumococcal vaccination in adults in the United States

Age ≥65

Chronic heart disease* (CHF, cardiomyopathy 포함, 고혈압은 해당 안됨)

Chronic lung disease¶ (COPD, emphysema, asthma 포함)

Chronic liver disease, cirrhosis

Diabetes mellitus

Cerebrospinal fluid leak

Cochlear implant

Current cigarette smoking

Alcohol use disorder

Sickle cell disease/other hemoglobinopathy

History of invasive pneumococcal diseaseΔ

Congenital or acquired immunodeficiencyפ

Congenital or acquired asplenia§

Human immunodeficiency virus infection§¥

Chronic kidney disease§

Nephrotic syndrome§

Leukemia§

Lymphoma§

Hodgkin disease§

Generalized malignancy§

Multiple myeloma§

Solid organ transplant§

Iatrogenic immunosuppression§‡

Pneumococcal vaccination is indicated for adults with risk factors for acquisition of or severe adverse outcomes from pneumococcal disease. These adults should receive either PCV20 alone or PCV15 followed by PPSV23. When administering the PCV15 and PPSV23 combination, PCV15 should be given first when possible. The recommended intervals between the two vaccines vary based on sequence and indication. Refer to the UpToDate text for additional detail.

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PCV20: 20-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.

* Including congestive heart failure and cardiomyopathies, excluding hypertension.

¶ Including chronic obstructive pulmonary disease, emphysema, and asthma.

Δ The United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) does not mention individuals with a prior history of invasive pneumococcal disease in their recommendations on pneumococcal vaccinations. We suggest pneumococcal vaccination in this population due to their increased risk for recurrent pneumococcal disease. Refer to the UpToDate text on pneumococcal vaccination in adults for additional detail.

◊ Includes B (humoral) or T lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease).

§ This is an immunocompromising condition. Some UpToDate authors differ from ACIP guidance on vaccine selection for immunocompromised individuals. Refer to the UpToDate text on pneumococcal vaccination in adults for additional information.

¥ HIV infection is an indication for pneumococcal vaccination, regardless of CD4 cell count.

‡ Treatment with any immunosuppressive drugs (including long-term glucocorticoids, tumor necrosis factor alpha inhibitors, cancer chemotherapy, and other cytokine inhibitors) or radiation therapy.

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TABLE 1. Recommendations for use of 15-valent pneumococcal conjugate vaccine in series with 23-valent pneumococcal polysaccharide vaccine or 20-valent pneumococcal conjugate vaccine in pneumococcal conjugate vaccine-naïve adults aged ≥19 years — United States, 2022

Medical indication group	Specific underlying medical condition	Age group, yrs
		19–64	≥65
None	None	None	1 dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 years later*
Underlying medical conditions or other risk factors	Alcoholism	1 dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 years later§	1 dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 years later*
	Chronic heart disease†
	Chronic liver disease
	Chronic lung disease¶
	Cigarette smoking
	Diabetes mellitus
	Cochlear implant
	CSF leak
	Congenital or acquired start highlightasplenia**end highlight
	Sickle cell disease or other start highlighthemoglobinopathies**end highlight
	Chronic renal failure**
	Congenital or acquired immunodeficiencies**,††
	Generalized malignancy**
	HIV infection**
	Hodgkin disease**
	Iatrogenic immunosuppression**,§§
	Leukemia**
	Lymphoma**
	Multiple myeloma**
	Nephrotic syndrome**
	Solid organ transplant**

Abbreviations: CSF = cerebrospinal fluid; PCV15 =15-valent pneumococcal conjugate vaccine; PCV20 = 20-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

* Adults with immunocompromising conditions, cochlear implant, or CSF leak might benefit from shorter intervals such as ≥8 weeks. These vaccine doses do not need to be repeated if given before age 65 years.

† Includes congestive heart failure and cardiomyopathies.

§ Adults with immunocompromising conditions, cochlear implant, or CSF leak might benefit from shorter intervals such as ≥8 weeks.

¶ Includes chronic obstructive pulmonary disease, emphysema, and asthma.

** Indicates immunocompromising conditions.

†† Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease).

§§ Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy.

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TABLE 2. Age-based policy options for use of 15-valent pneumococcal conjugate vaccine or 20-valent pneumococcal conjugate vaccine in adults presented for a vote and considerations by the Advisory Committee on Immunization Practices — United States, October 2021

Proposed policy	Considerations raised during October 2021 ACIP meeting in favor of the option	Outcome (votes in favor: against)
Adults aged ≥50 years who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV20 or PCV15). If PCV15 is used, this should be followed by a dose of PPSV23.	Might reduce existing pneumococcal disease disparity in adults aged 50–64 years.	Rejected (4:11)
	Age-based recommendation is easier to implement than risk-based recommendation.
	Might provide more opportunities to vaccinate adults before underlying conditions develop.
Adults aged ≥65 years who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV20 or PCV15). If PCV15 is used, this should be followed by a dose of PPSV23.	Potential for waning vaccine-induced immunity makes it favorable to vaccinate later in life when risk for disease is higher.	Affirmed (15:0)
	Consistently cost saving in cost-effectiveness analyses.
	Still provides an opportunity for higher PCV coverage in adults compared with current recommendations.
	No evidence that lowering the age-based recommendation will reduce disparity in vaccine-preventable disease compared with risk-based recommendations.

Abbreviations: ACIP = Advisory Committee on Immunization Practices; PCV = pneumococcal conjugate vaccine ; PCV15 = 15-valent PCV; PCV20 = 20-valent PCV; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

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REF. 2022.06.29 uptodate

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm?s_cid=mm7104a1_w#T1_down