Key point: The CDC Advisory Committee on Immunization Practices (ACIP) recommends that cigarette smoking be added to the list of indications for use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults 19 to 64 years of age.
Finer points: In October, ACIP voted on new recommendations for use of the pneumococcal vaccine for prevention of invasive pneumococcal disease. A key recommendation was the addition of cigarette smoking as an indication for the vaccine in adult patients. The proposed wording of the revised recommendation was "Persons aged 19 through 64 years who smoke cigarettes should receive a single dose of PPSV23 and smoking cessation counseling." This recommendation was based on a multitude of data showing that patients who smoke are at substantially increased risk for invasive pneumococcal disease. Nuorti and colleagues conducted a population-based case-control study to assess risk factors for pneumococcal disease. The investigators reported that cigarette smoking was the strongest independent risk factor (odds ratio 4.1 [95% CI 2.4–7.3]) for invasive pneumococcal disease among immunocompetent adults 18 to 64 years old. Passive smoking among nonsmokers was the second strongest risk factor (2.5 [1.2–5.1]) for the disease. The investigators also noted dose–response relationships for the current number of cigarettes smoked per day, pack–years of smoking, and time since quitting. Pastor and colleagues reported similar findings, with smoking being a risk factor for pneumococcal disease among young and middle-aged patients. The 2007 Infectious Diseases Society of America and American Thoracic Society guidelines for the management of community-acquired pneumonia (CAP) in adults also recommended that smoking cessation be a goal for patients hospitalized with CAP who smoke and that smokers who do not quit be vaccinated with both the pneumococcal and influenza vaccines.
What you need to know: Approximately 20% of U.S. adults are estimated to smoke cigarettes. Smoking is thought to cause structural changes in the respiratory tract and a decrease in immune response, which makes smokers more susceptible to developing bacterial and viral infections. ACIP’s recommendation for vaccinating adult patients who smoke is currently under review by CDC and the Department of Health and Human Services and will become official when published in CDC's Morbidity and Mortality Weekly Report. If approved, the new ACIP recommendation will significantly increase the number of adult patients who qualify for the pneumococcal vaccine. This offers an opportunity for pharmacists to become actively involved in identifying patients who smoke, vaccinating them against pneumococcal disease, and counseling them on smoking cessation options and the harmful effects of secondhand smoke. Community-based vaccination programs can easily identify patients at greatest risk for pneumococcal disease and improve overall vaccination rates.
What your patients need to know: Adult patients who currently smoke should be told that they are at an increased risk for invasive pneumococcal disease. Educate patients about the benefits of receiving the pneumococcal vaccine and counsel them on the importance of smoking cessation and avoiding secondhand smoke.