title: Dosing regimen of the 23-valent pneumococcal vaccination: a systematic review.
abstract: BACKGROUND
  Currently, one lifetime booster of a 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for those at highest risk of invasive pneumococcal disease (IPD) 3-5 years after initial vaccination. Due to a lack of evidence on multiple revaccinations, recommendations on repeat revaccination do not exist. We aimed to determine the optimal dose and timing of PPV23 booster in high-risk groups.
  
  
  METHODS
  We searched Google Scholar, Cochrane, EMBASE, Classic EMBASE, and PubMed for articles published in English and French using the MeSH terms pneumococcal infection, invasive pneumococcal disease, pneumonia, pneumo23, pneumovax 23, PPV23, and 23-valent. Articles were included if they examined dosing regimens of PPV23 (i.e., PPV23 priming and boosting) in adult populations, pediatric populations or both. Two authors independently assessed all titles and abstracts. All potentially relevant articles were chosen by consensus and retrieved for full text review. Two authors independently conducted the inclusion assessment.
  
  
  RESULTS
  Database searches resulted in a total of 1233 articles. The review by title and abstracts resulted in the exclusion of 1170 articles, 53 articles were fully reviewed, 2 articles were identified using Google Scholar and 12 articles were finally included. The majority of evidence consistently indicated an increase in antibody response following PPV23 revaccination in both adult and pediatric populations. Evidence on multiple revaccinations was limited and mixed. Revaccination with PPV23 was well tolerated.
  
  
  CONCLUSIONS
  The majority of evidence reviewed supports PPV23 revaccination in both adult and pediatric populations. However, data on multiple booster PPV23 vaccinations in these populations is needed.
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors: Chelsea A
authors: CA
authors: Caya
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors: Constantina
authors: C
authors: Boikos
authors: Division of Vaccine Preventable Diseases, Public Health Agency of Canada, Ottawa, ON, Canada.
authors: Shalini
authors: S
authors: Desai
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Department of Pediatrics, Division of Infectious Diseases, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada; Quebec Institute of Public Health, Montreal, QC, Canada; McGill University Health Centre, Vaccine Study Centre, Research Institute of the MUHC, Montreal, QC, Canada. Electronic address: caroline.quach@mcgill.ca.
authors: Caroline
authors: C
authors: Quach
mesh_terms: D000328:Adult; D002648:Child; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary / Q000706:statistics & numerical data; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D011014:Pneumonia / Q000517:prevention & control; D012307:Risk Factors; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines
keywords: 23-Valent pneumococcal vaccinations; Invasive pneumococcal disease, Streptococcal pneumonia; Systematic review