Pneumococcal vaccine. Health and Public Policy Committee, American College of Physicians.

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.