Pneumonia vaccines -- Is there any qualified report to show GPs CLL suffers need it every 5 years?

[Mick491]

I was diagnosed with CLL in June 2007. I had 5 doses of FCR in 2010/11 with success. Despite being told all my bloods are within the 'normal' range, 3 out of the last 4 years I have been admitted to hospital and treated with IV antibiotics for pneumonia and temps of 40.5

I originally received the pneumococcal vaccine in 2005 because I had been put on subcutaneous methotrexate for severe arthritis. (I am aware methotrexate in itself compromises my immune system and I have monthly blood tests because of this). However, from the information on this site the goal posts in relation to pneumonia vaccines appear to have changed. When I received the vaccine I was told it was for life and the current information now says you need it every 5 years. It appears many GPs are not aware of this.

I have a very understanding GP because as well as the CLL, I was disabled with spinal injuries as a fire-fighter, then 4 pneumonias, a heart attack (with surgery leading to another pneumonia) last year, in July this year I had a 14 day admission with salmonella, campylobacter and kidney failure. So despite the normality of my bloods my immune system is definitely compromised. Because of my history with pneumonia I am terrified of this winter.

I have approached my GP and explained about the information available on this site and the various pneumonia alternative vaccines. He listened to what I have said and has kindly done an immunoglobulin test which I am awaiting results. If that comes back ok I am hoping to convince him to give me another pneumococcal vaccine and soon.

Is there anyone on this site that can point me in the direction of authorative guidance for GPs relating to giving this vaccine to immune compromised patients.

[Cllcanada Top Poster CURE Hero]

Might try this document. It is a recommendation to the Centers for Disease Control and Prevention in the U.S.

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

cdc.gov/mmwr/preview/mmwrht...

~chris

[AussieNeil Administrator]

And similarly from Australia - as you say, every 5 years (up to 3 doses):

health.gov.au/internet/immu...

You would fall into Category A: Conditions associated with the highest increased risk of IPD (invasive pneumococcal disease)

"immunocompromising conditions, including:

:

:

- haematological and other malignancies"

Read the section Adults aged ≥18 years, in particular the subsections:

Use of 13vPCV and

Use of 23vPPV

Neil

[Mijoed]

Important to note the sequence / timing.

PCV13 should be given first and then PPSV23 given no sooner than EIGHT WEEKS later.

If you already had PPSV23 then you should wait ONE YEAR before having PCV13.

Revaccination after AT LEAST FIVE YEARS with PPSV23.

[HAIRBEAR_UK Founder Admin]

UK haematologists advise five years upkeep for CLL patients but UK documentation suggesting five years for CLL patients is not readily available or clear. Your specialist can write to your GP or provide you a note.

Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia onlinelibrary.wiley.com/doi... may be useful

From immunization recommendations:

"Vaccination against Streptococcus pneumoniae (using a conjugate vaccine) and Haemophilus influenzae type B is recommended at diagnosis. Patients who respond to vaccination and subsequently develop recurrent bacterial infections should be revaccinated if S. pneumoniae and Hib antibody levels have fallen.

Also under replacement immunoglobin therapy indications:

Department of Health guidelines on immunoglobulin use recommend that if a patient received unconjugated pneumococcal or other polysaccharide vaccine challenge many years ago and specific antibody levels are low, it would be reasonable to re-vaccinate before prescribing immunoglobulin replacement therapy (Wimperis et al, 2011).

Is your consultant aware of your repeated infections? Ensure you consultant is copied in on the results of your immunoglobin tests.