Washington Editor

WASHINGTON - A government advisory panel Wednesday recommended that adults ages 19 to 64 who smoke or have asthma receive a pneumococcal polysaccharide vaccine, which is routinely recommended for seniors and people older than age 2 with certain risk factors, such as those with cancer or HIV infection.

The recommendation is the first time a vaccine has been recommended specifically for smokers by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).

Smokers and people with asthma are at an increased risk of being infected with pneumococcal diseases, which are caused by common bacteria and can lead to potentially serious bacterial infections, such as pneumonia, meningitis and bacteremia, a blood infection.

Whitehouse Station, N.J.-based Merck & Co. is the sole supplier of the only U.S.-approved pneumococcal polysaccharide vaccine (PPSV23), which is sold under the brand name Pneumovax 23.

The product is indicated for patients 50 years or older or anyone older than 2 with certain risk factors, including chronic cardiovascular or pulmonary diseases, diabetes, chronic liver disease or those with functional or anatomic asplenia.

The ACIP also voted Wednesday to revise the recommendations for use of PPSV23 in certain populations, specifically children at risk and Alaskan Natives and American Indians.

The panel said that Alaskan Native and American Indian children ages 2 to 5 years should not receive vaccinations of PPSV23 after administration of the routine childhood pneumococcal conjugate vaccine (PCV). However, in special situations, public health authorities may consider recommending PPSV23 after PCV for those children living in areas where there is an increased risk of invasive pneumococcal disease, the committee said.

The revisions also included a recommendation against routine use of PPSV23 in Alaskan Native or American Indian people younger than 65 unless they have underlying medical conditions or live in high-risk areas.

The ACIP panel also recommended revaccination of a second dose of PPSV23 five years after the first dose of PPSV23 in children older than 2 who are immunocompromised, have sickle cell disease or functional or anatomic asplenia.

In contrast to influenza vaccine, pneumococcal vaccine is not recommended annually.

Poor Children Missing Pneumonia Vaccine

A day after the panel's vote, the CDC reported that pneumococcal vaccines are not reaching young children in developing countries.

Pneumococcal disease is the leading cause of death among children younger than 5 years, with an annual rate of death of about 1 million in that age group.

Studies in the U.S. have demonstrated that vaccination with PCV, which is marketed by Collegeville, Pa.-based Wyeth Pharmaceuticals Inc. as Prevnar (diphtheria CRM197 protein), has resulted in a 77 percent reduction in invasive pneumococcal disease among children younger than 5 years and a 39 percent decrease in pneumonia-related hospitalizations in that age group, according to the CDC.

While 26 countries worldwide offered PCV to children as part of national immunization programs or had the vaccine in widespread use as of August, none of those nations were poor developing countries, which account for about 97 percent of pneumonia cases in young children, the CDC said.

The high cost of PCV has restricted the number of countries from routinely using the vaccine, health officials said.

The GAVI Alliance, an organization that aligns public and private resources to create global access to vaccines, made funding available through 2015 for 72 countries for pneumococcal vaccine for children, health officials noted.

The Advanced Market Commitment (AMC) for Vaccines, a mechanism that provides a binding contract offered by countries and private donors that guarantees vaccine makers a viable market for next-generation PCVs and ensures a sustainable and affordable supply of those vaccines for low-income countries, was established in 2006 to complement the financial support of the GAVI Alliance.

The AMC offers access to nearly $1.5 billion in vaccine financing for the next seven to 10 years, the CDC said. During that period, GAVI-eligible countries will be expected to pay a small copayment, which currently is about 30 cents per dose, for each dose of PCV. Under the terms of AMC, those nations are guaranteed a predictable, low price and access to supplies for up to 10 years after AMC funding is depleted.

The CDC noted that other vaccines have been slow to be introduced in developing countries, including those to protect against hepatitis B and Haemophilus influenzae Type b.

The global use of pneumococcal vaccine in children could prevent up to 7.7 million deaths by 2030, health officials said.