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Safety of Revaccination With Pneumococcal Polysaccharide Vaccine
Lisa A. Jackson, MD, MPH;
Patti Benson, MPH;
Vishnu-Priya Sneller, MBBS, PhD;
Jay C. Butler, MD;
Robert S. Thompson, MD;
Robert T. Chen, MD, MA;
Linda S. Lewis, DVM, MPVM;
George Carlone, PhD;
Frank DeStefano, MD, MPH;
Patricia Holder, MS;
Tamar Lezhava, MD;
Walter W. Williams, MD, MPH
JAMA. 1999;281:243-248.
Context Revaccination of healthy adults with pneumococcal polysaccharide vaccine (PPV) within several years of first vaccination has been associated with a higher than expected frequency and severity of local injection site reactions. The risk of adverse events associated with revaccination of elderly and chronically ill persons 5 or more years after first vaccination, as is currently recommended, has not been well defined.
Objective To determine whether revaccination with PPV at least 5 years after first vaccination is associated with more frequent or more serious adverse events than those following first vaccination.
Design Comparative intervention study conducted between April 1996 and August 1997.
Participants Persons aged 50 to 74 years either who had never been vaccinated with PPV (n=901) or who had been vaccinated once at least 5 years prior to enrollment (n=513).
Intervention PPV vaccination.
Main Outcome Measures Postvaccination local injection site reactions and prevaccination concentrations of type-specific antibodies.
Results Those who were revaccinated were more likely than those who received their first vaccinations to report a local injection site reaction of at least 10.2 cm (4 in) in diameter within 2 days of vaccination: 11% (55/513) vs 3% (29/901) (relative risk [RR], 3.3; 95% confidence interval [CI], 2.1-5.1). These reactions resolved by a median of 3 days following vaccination. The highest rate was among revaccinated patients who were immunocompetent and did not have chronic illness: 15% (33/228) compared with 3% (10/337) among comparable patients receiving their first vaccinations (RR, 4.9; 95% CI, 2.4-9.7). The risk of these local reactions was significantly correlated with prevaccination geometric mean antibody concentrations.
Conclusions Physicians and patients should be aware that self-limited local injection site reactions occur more frequently following revaccination compared with first vaccination; however, this risk does not represent a contraindication to revaccination with PPV for recommended groups.
Author Affiliations: Immunization Studies Program, Center for Health Studies, Group Health Cooperative of Puget Sound (Drs Jackson and Thompson and Ms Benson) and the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington (Dr Jackson), Seattle; and National Immunization Program (Drs Sneller, Chen, Lewis, DeStefano, and Williams), National Center for Infectious Diseases (Drs Butler, Carlone, and Lezhava and Ms Holder), Vaccine Safety Datalink Project (Drs Jackson, Thompson, Chen, and DeStefano and Ms Benson), Centers for Disease Control and Prevention, Atlanta, Ga. Dr Williams is now the Associate Director for Minority Health, Centers for Disease Control and Prevention.
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