Pneumococcal Polysaccharide Vaccine (PPSV23)

Usage

Pneumococcal polysaccharide vaccine (PPSV23) is prescribed for the prevention of invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae, including pneumonia, meningitis, bacteremia, and sepsis. It protects against 23 serotypes of the bacteria. Its pharmacological classification is vaccine. PPSV23 works by stimulating the immune system to produce antibodies against the 23 pneumococcal serotypes included in the vaccine. These antibodies then help to fight off infection if the person is exposed to the bacteria.

Alternate Names

The official generic name is Pneumococcal Polysaccharide Vaccine. An alternate name frequently encountered is 23-valent pneumococcal polysaccharide vaccine, and commonly abbreviated to PPSV23. One prominent brand name is Pneumovax 23.

How It Works

Pharmacodynamics: PPSV23 triggers an immune response, primarily a T cell-independent B cell response, leading to the production of serotype-specific antibodies against the capsular polysaccharides of the 23 included S. pneumoniae serotypes. These antibodies opsonize the bacteria, facilitating phagocytosis and clearance by immune cells.

Pharmacokinetics: PPSV23 is administered intramuscularly (IM) or subcutaneously (SC). The polysaccharides in the vaccine are not significantly absorbed from the injection site. The vaccine’s primary action is localized immune stimulation, resulting in the production of antibodies released into the bloodstream. Information on specific metabolic pathways and elimination is limited as the main components are polysaccharides.

Mode of Action/Receptor Binding, Enzyme Inhibition, Neurotransmitter Modulation: The primary mode of action is based on antibody-mediated immunity. There is no direct interaction with specific cellular receptors, enzyme inhibition, or neurotransmitter modulation. The capsular polysaccharides act as antigens, triggering an adaptive immune response in the body.

Elimination Pathways: Information on elimination is limited as the vaccine primarily initiates an immune response. The polysaccharides are likely degraded over time.

Dosage

Standard Dosage

Adults:

A single 0.5 mL dose is administered IM or SC. For adults ≥65 years who have not received a pneumococcal conjugate vaccine (PCV) or whose vaccination history is unknown, options include a single dose of PCV15 or PCV20, or a dose of PCV15 followed by PPSV23 at least one year later. If a patient has already received PPSV23, a dose of PCV15, PCV20, or PCV21 may be administered at least 1 year after the PPSV23 dose. For adults 19-64 years with certain medical conditions or other risk factors, these same recommendations apply. For adults ≥65 who received a PPSV23 dose before age 65, a second dose of PPSV23 is recommended at least 5 years after the first dose.

Children (≥2 years):

A single 0.5 mL dose administered IM or SC. In children, pneumococcal conjugate vaccines (PCVs, such as PCV13, PCV15, or PCV20) are generally preferred over PPSV23 for primary vaccination. For children with certain medical conditions or other risk factors PPSV23 may be recommended in addition to PCV, generally at least 8 weeks after the PCV dose.

Special Cases:

• Elderly Patients: As per adult recommendations above.

• Patients with Renal/Hepatic Impairment: No dose adjustment is generally necessary for these patients.

• Patients with Comorbid Conditions: For patients with immunocompromising conditions, PCV is preferred over PPSV23 for primary vaccination. PPSV23 may be administered at least 8 weeks after the PCV dose. Individuals with chronic illnesses (e.g., heart, lung, liver, or kidney disease, diabetes) should receive the pneumococcal vaccine according to current guidelines based on age and prior vaccination history.

Clinical Use Cases

The dosage for PPSV23 doesn’t change in these clinical settings, rather it is indicated for certain high-risk patient groups.

Dosage Adjustments

Dose adjustments are not routinely made for PPSV23 based on organ dysfunction.

Side Effects

Common Side Effects:

Pain, redness, and swelling at the injection site; mild fever; fatigue; myalgia.

Rare but Serious Side Effects:

Severe allergic reactions (anaphylaxis).

Long-Term Effects:

No significant long-term side effects have been identified.

Adverse Drug Reactions (ADR):

Severe allergic reactions including anaphylaxis require immediate medical intervention.

Contraindications

• Absolute Contraindications: Severe allergic reaction (anaphylaxis) to a previous dose of any pneumococcal vaccine or to any component of the vaccine.

• Relative Contraindications: Moderate or severe acute illness (vaccination should be postponed until the illness resolves).

Drug Interactions

No significant drug interactions have been identified. Concurrent administration with other vaccines is generally acceptable, but different injection sites should be used. Concomitant use of PPSV23 with PCV should follow recommended guidelines.

Pregnancy and Breastfeeding

PPSV23 is considered safe in pregnancy and breastfeeding. Maternal vaccination can provide passive immunity to the infant through placental transfer and breast milk.

Drug Profile Summary

• Mechanism of Action: Stimulates T cell-independent B cell response, producing serotype-specific antibodies against 23 pneumococcal serotypes.

• Side Effects: Injection site reactions (pain, redness, swelling), fever, fatigue, myalgia. Rarely, anaphylaxis.

• Contraindications: Anaphylaxis to previous pneumococcal vaccine or vaccine component.

• Drug Interactions: No significant interactions.

• Pregnancy & Breastfeeding: Safe.

• Dosage: 0.5 mL IM or SC, single dose for adults and children ≥2 years. Special considerations apply to those with high risk conditions.

• Monitoring Parameters: Monitor for adverse reactions, particularly allergic reactions.

Popular Combinations

PPSV23 is sometimes used in combination with conjugate pneumococcal vaccines.

Precautions

Patients should be screened for contraindications and allergies prior to vaccination.

FAQs

Q1: What is the recommended dosage for Pneumococcal Polysaccharide Vaccine?

A: 0.5 mL IM or SC, single dose for adults and children ≥2 years.

Q2: Who should receive PPSV23?

A: Adults ≥65, individuals 2-64 years old with certain high-risk conditions (e.g. chronic illnesses, immunocompromising conditions), and sometimes following PCV13, PCV15, or PCV20.

Q3: What are the common side effects?

A: Injection site reactions (pain, redness, and swelling), mild fever, fatigue, muscle aches.

Q4: Can PPSV23 be given during pregnancy or while breastfeeding?

A: Yes, it is considered safe and may offer passive immunity to the infant.

Q5: Are there any contraindications to PPSV23?

A: Severe allergic reaction to a prior dose of PPSV23 or any vaccine component.

Q6: How does PPSV23 work?

A: It triggers the body to create antibodies against 23 specific types of pneumococcal bacteria.

Q7: How effective is PPSV23?

A: The effectiveness varies, but it can significantly reduce the risk of serious pneumococcal infections in certain populations.

Q8: Can PPSV23 be given with other vaccines?

A: Yes, usually with different injection sites.

Q9: What is the difference between PPSV23 and PCV?

A: PPSV23 is a polysaccharide vaccine, typically used in adults, which elicits a T-cell-independent response. PCVs are conjugate vaccines, generally preferred in children, that elicit a T-cell-dependent response, resulting in stronger and longer-lasting immunity, as well as immunologic memory.

Q10: How long does the protection from PPSV23 last?

A: Protection wanes over time, and booster doses may be needed for some individuals.

Please note that this information is current as of February 17, 2025, and may be subject to change with updates to medical guidelines and research.