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.
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.
Comparative intervention study conducted between
April 1996 and August 1997.
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).
Main Outcome Measures
Postvaccination local injection site
reactions and prevaccination concentrations of type-specific
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.
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.