Preventing Pneumococcal Infections among Persons Who Smoke Cigarettes or Have Asthma

Background:
About 43.3 million U.S. adults smoke cigarettes and 7.1 million have asthma. Recent studies demonstrate increased risk of invasive pneumococcal disease (IPD) associated with these conditions but neither has been an Advisory Committee for Immunization Practices (ACIP) indication for use of pneumococcal polysaccharide vaccine (PPV).

Objectives:
To determine whether asthma and cigarette smoking should be indications for PPV when the ACIP updates its current recommendations.

Methods:
We used data from a CDC study of current and proposed ACIP indications for PPV among adults with invasive pneumococcal disease (IPD). Cases of IPD were illnesses with pneumococcus isolated from blood or other normally sterile sites in adults aged 18-64 years. Data from the National Health Interview Survey were used as denominators for rates. We compared risk of IPD among persons with asthma or current cigarette smoking and estimated the number needed to vaccinate (NNV) to prevent a case of IPD.

Results:
Among 1,124 cases of IPD aged 18-64 years, 600 (53%) occurred in smokers and 140 (12%) were in those with asthma. The prevalence of other, current ACIP indications among IPD cases who were smokers or asthmatics was 75% and 80%, respectively. Estimated IPD rates ranged from 40 to 55 per 100,000 among persons with chronic lung or heart disease or diabetes, which are current ACIP indications. Among smokers and asthmatics aged 45-64 years, the estimated IPD rates per 100,000 were 42 and 30 and the NNVs were 4,000 and 5,600, respectively.

Conclusions:
The risk of IPD and NNV among adult asthmatics and smokers are comparable to current ACIP indications for PPV. Most smokers and asthmatics also have other ACIP indications. Because smoking cessation and asthma management are frequently addressed during primary care visits, recommending PPV to these groups may increase coverage among persons at increased risk of IPD.