KLIMIK JOURNAL, vol.31, no.1, pp.2-18, 2018 (ESCI)
Pneumococcal diseases, including pneumonia with or without bacteremia, remain an important cause of morbidity and mortality in adults, especially among the elderly and those with certain medical conditions, including immunocompromising conditions all over the world. Two pneumococcal vaccines are currently licensed for adults in Turkey, 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23). PPSV23 has been available for many years for use in adults. A 7-valent pneumococcal conjugate vaccine (PCV7) included in the Expanded Programme on Immunization for use in infants and children in 2008, and thereafter PCV13 replaced PCV7 in 2011. Recently, the Ministry of Health of Turkey accepted risk groups for vaccine-preventable diseases, and implemented their immunization schedules in accordance with the decisions of Immunization Advisory Committee, including adult pneumococcal vaccination greatly compatible with those of updated U.S. Advisory Committee on Immunization Practices (ACIP) recommendations such as PCV13 for selected high-risk adults and for all adults >= 65 years of age. Furthermore, surveillance of invasive pneumococcal disease has already been included as part of the Surveillance of Vaccine-Preventable Invasive Bacterial Diseases announced that would be started soon in Turkey. In this consensus report prepared by Study Group for Adult Immunization of the Turkish Society of Clinical Microbiology and Infectious Diseases, relevant literature and international recommendations were reviewed, and recommendations agreed are presented. Examples of some selected recommendations are as follows:  All individuals aged >= 65 years should receive PCV13 followed by PPSV23, as well as adults of any age with the high-risk conditions (ie, patients with an immunocompromising condition, functional or anatomic asplenia, a cerebrospinal fluid leak, and a cochlear implant).  Pneumococcal vaccination is also recommended for adults <65 years of age at risk of pneumococcal diseases (ie, patients with chronic heart disease, chronic lung disease, chronic liver disease, alcoholism, diabetes mellitus, and smokers). Such patients receive PPSV23 alone; however, PCV13 followed by PPSV 23 could be useful as well.  Adults eligible for both vaccines should be given PCV13 first.  Even though PPSV23 is administered >= 1 year after PCV13 for most immunocompetent adults, it should be administered >= 8 weeks later for high-risk patients.  In patients who have already received PPSV23, >= 1 year should elapse before they are given PCV13.  For immunocompromised and asplenic patients, a booster dose of PPSV23 is recommended >= 5 years after the first dose.  A booster dose of PCV13 is not recommended for any age group.  Both vaccines may be administered concurrently with influenza vaccine, but at a separate site.  Use of PCV13 in adults may not always provide expected benefit because of the trend for vaccine strains to disappear from the population following childhood immunization with same vaccine. Therefore, surveillance for adult pneumococcal diseases is highly important to understand local epidemiology including serotype distribution and antibiotic resistance rates.