Should all patients with asthma get the pneumococcal vaccine?

Should all patients with asthma get the pneumococcal vaccine?

The simple answer is yes, unless there are contraindications. The explanation is below.

The CDC considers asthmatics at increased risk of pneumococcal disease and therefore have suggested that all asthmatics ages 19 to 64 receive pneumococcal vaccine (Pneumovax 23). The Pneumovax 23 package insert states that anyone who is at “increased risk” receive the vaccine. CDC recommendation is based upon a study that showed that asthmatics are at increased risk. CDC website states that asthmatics ages 19 to 64 receive the vaccine.

What is the recommended age range for patients with asthma get the pneumococcal vaccine?

Ages 19-64.

Which pneumococcal vaccine should patients with asthma get?

Pneumovax 23.

Should patients with asthma receive Prevnar 13?

As of 2014, the answer is no. Patients should receive Pneumovax 23.

Can you please explain when and why the recommendations for vaccination were changed for people with asthma and for cigarette smokers?

The 1997 CDC recommendations for the use of PPSV exclude asthma in the chronic pulmonary disease category because no data on increased risk of pneumococcal disease among people with asthma were available when the recommendation was issued. In 2008, the Advisory Committee on Immunization Practices (ACIP) reviewed new information that suggests that asthma is an independent risk factor for pneumococcal disease among adults. ACIP also reviewed new information that demonstrates an increased risk of pneumococcal disease among smokers. Consequently, ACIP recommends to include both asthma and cigarette smoking as risk factors for pneumococcal disease among adults age 19 through 64 years and as indications for PPSV23.

In its September 2010 publication of updated recommendations for prevention of invasive pneumococcal disease among adults, ACIP recommends vaccinating adult asthmatics with PPSV23. Should I give PPSV23 to people with mild, intermittent asthma or exercise-induced asthma? Why isn't PPSV23 recommended for asthmatic children?

PPSV23 is recommended for adults 19 years and older with all types of asthma. Available data do not indicate that asthma alone increases the risk of invasive pneumococcal disease among people younger than 19 years, so PPSV23 is not currently recommended for people younger than 19 years with asthma. For more information, go to

For whom is the 23-valent pneumococcal polysaccharide vaccine (PPSV23) recommended?

PPSV23 vaccine is recommended for all people who meet any of the criteria below:

1. All adults age 65 yrs and older

2. Age 2 through 64 yrs with any of the following conditions:
a. cigarette smokers age 19 yrs and older
b. chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies; excluding hypertension)
c. chronic pulmonary disease (including COPD and emphysema, and for adults ages 19 years and older, asthma)
d. diabetes mellitus
e. alcoholism
f. chronic liver disease, cirrhosis
g. candidate for or recipient of cochlear implant
h. cerebrospinal fluid (CSF) leak
i. functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)
j. immunocompromising conditions (e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin's disease, lymphoma, multiple myeloma, generalized malignancy) or on immunosuppressive therapy
k. solid organ transplantation; for bone marrow transplantation, see
l. chronic renal failure or nephrotic syndrome

Is pneumococcal polysaccharide vaccine (PPSV23) contraindicated in pregnancy? Our patient has asthma and is pregnant.

No. According to the 2014 adult immunization schedule, PPSV23 is recommended in pregnancy if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications).


Indications for pneumococcal vaccine (Pneumovax 23) in asthma. AAAAI
Ask the Experts: Pneumococcal Vaccines (PCV13 and PPSV23)
Adult vaccine schedule - CDC (PDF)
Image source: Streptococcus pneumoniae from Wikipedia, the free encyclopedia, public domain.

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