Vaksin Pneumokokus (PPSV23)

Dewasa 65 tahun ke atas, individu usia 2-64 tahun dengan kondisi medis tertentu seperti diabetes, penyakit jantung, dan penyakit paru.

Severe allergic reaction to previous dose or any component (phenol preservative). Moderate to severe acute illness (defer). No age-specific contraindications in approved range.

Very common: injection site pain (61%), swelling (21%), erythema (16%). Common: fatigue (14%), headache (17%), myalgia (12%), fever (2%). Arthus-type reaction possible with revaccination (especially if interval <5 years) — extensive limb swelling. Revaccination reactions generally more pronounced than primary. Serious adverse events: rare (<0.1%).

Single 0.5 mL dose, IM (preferred) or SC. Primary vaccination: single dose. Revaccination (single additional dose): at ≥5 years for immunocompromised, functional/anatomic asplenia, chronic renal failure, or nephrotic syndrome. Adults ≥65: single revaccination if first dose was before age 65 and ≥5 years have elapsed. Maximum 2 lifetime doses. Inject in deltoid muscle.

Observational studies: 50–80% effectiveness against invasive pneumococcal disease (IPD) from vaccine serotypes in immunocompetent adults. Limited effectiveness against non-bacteremic pneumonia (20–40%). Protection wanes over 5–10 years. No effectiveness against nasopharyngeal carriage (cannot induce herd protection). Less effective in immunocompromised patients.

Store at +2°C to +8°C. Do not freeze. Protect from light. Ready-to-use solution — no reconstitution needed. Shelf life: 24 months.

Can be co-administered with influenza, COVID-19, and other inactivated vaccines. When used sequentially with PCV13/15: administer PCV first, then PPSV23 ≥8 weeks later (immunocompromised) or ≥1 year later (immunocompetent adults ≥65y). PCV20 eliminates need for sequential PPSV23. No drug interactions.

Safe in pregnancy (inactivated polysaccharide). Limited data but no teratogenicity signal. Administer if indicated (e.g., asplenia, immunocompromised). Breastfeeding: safe.

Breastfeeding: PPSV23 (Pneumovax 23®, polysaccharide vaccine) is compatible with breastfeeding. As an inactivated vaccine, it poses no risk to the nursing infant. Anti-pneumococcal antibodies may be transferred through breast milk, providing passive protection. No interruption of breastfeeding is required.

Not approved for <2 years (T-cell independent response is poor in young children — conjugate vaccines used instead). Children ≥2 years with high-risk conditions: PPSV23 after completing PCV13/15 series (≥8 weeks later).

Primary target population (≥65 years). Immune response may be reduced compared to younger adults. Revaccination response lower than primary. Transition to PCV20 simplifies elderly immunization schedule.

T-cell independent response: does not generate memory B cells, so revaccination is limited to one additional dose (at most). Cannot prime immune system like conjugate vaccines. Do NOT confuse with PCV13/15/20 (conjugate vaccines with different immunological properties). Hyposplenic/asplenic patients: vaccinate ≥2 weeks before elective splenectomy. Current ACIP trend: PCV20 monovalent replacing PCV15+PPSV23 sequential approach.