REVACCINATION

PNEUMOCOCCAL POLYSACCHARIDE VACCINE
Following vaccination with PPV23, antibody levels decline after 5-
10 years and decrease more rapidly in some groups than others.
However, the relationship between antibody titer and protection
from invasive disease is not certain (i.e., higher antibody level does
not necessarily mean better protection), so the ability to define the need for revaccination based only on serology is limited. In addition,
currently available pneumococcal polysaccharide vaccines elicit a T-independent response, and do not produce a sustained increase (“boost”) in antibody titers. Available data do not indicate a substantial increase in protection in the majority of revaccinated persons.

Because of the lack of evidence of improved protection with multiple
doses of pneumococcal vaccine, routine revaccination of
immunocompetent persons previously vaccinated with 23-
valent polysaccharide vaccine is not recommended. However,
revaccination is recommended for persons 2 years of age and older
who are at highest risk for serious pneumococcal infection and for
those who are likely to have a rapid decline in pneumococcal antibody
levels. Only one PPV23 revaccination dose is recommended
for high risk persons. The second dose should be administered five or more years after the first dose. Revaccination 3 years after the previous dose may be considered for children at highest risk for severe pneumococcal infection who would be aged 10 years or less at the time of revaccination, including children who received PCV7.

Persons at highest risk include all people >2 years of age with functional or anatomic asplenia (e.g., sickle cell disease or splenectomy), HIV infection, leukemia, lymphoma, Hodgkins disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome, or other conditions associated with immunosuppression (e.g., organ or bone marrow transplantation) and those receiving immunosuppressive chemotherapy, including long term corticosteroids. Persons aged 65 years and older should be administered a second dose of pneumococcal vaccine if they received the vaccine more than 5 years previously, and were less than 65 years of age at the time of the first dose.

PNEUMOCOCCAL CONJUGATE VACCINE
Revaccination after an age-appropriate primary series with PCV7 is not currently recommended.

Source: CDC's Epidemiology & Prevention of Vaccine-Preventable Diseases (Pink Book) chapter 17 pages, 241-242. Click here to view the entire chapter in PDF format.