From the CDC guidelines: http://www.cdc.gov/mmwr/preview/mmwrhtml/00047135.htm
Duration of Antibody Levels
"Levels of antibodies to most pneumococcal vaccine antigens remain elevated for at least 5 years
in healthy adults. In some persons, antibody concentrations decrease to prevaccination levels by 10 years
(56,57). A more rapid decline (i.e., within 3-5 years after vaccination) in antibody concentrations may occur in certain children who have undergone splenectomy following trauma and in those who have sickle cell disease (58,59). Similar rates of decline can occur in children with nephrotic syndrome (60). Antibody concentrations also have declined after 5-10 years in elderly persons, persons who have undergone splenectomy, patients with renal disease requiring dialysis, and persons who have received transplants (24,56,57,61-63). Low or rapidly declining antibody concentrations after vaccination also have been noted among patients with Hodgkins disease (64) and multiple myeloma (65). However, these quantitative measurements of antibodies do not account for the quality of the antibody being produced and the level of functional immune response. Tests measuring opsonophagocytic activity and the quality of antibodies produced (i.e., avidity for pneumococcal antigens) may ultimately be more relevant for evaluating response to pneumococcal vaccination (66)."
REVACCINATION: Duration of Immunity
"Following pneumococcal vaccination, serotype-specific antibody levels decline after 5-10 years and decrease more rapidly in some groups than others (56,57,61-63), which suggests that revaccination may be indicated to provide continued protection. However, data concerning serologic correlates of protection are not conclusive, which limits the ability to precisely define indications for revaccination based on serologic data alone. Polysaccharide vaccines, including the currently available pneumococcal vaccine, do not induce T-cell-dependent responses associated with immunologic memory. Antibody levels increase after revaccination, but an anamnestic response does not occur (91). The overall increase in antibody levels among elderly persons has been determined to be lower after revaccination than following primary vaccination (92). Long-term follow-up data concerning antibody levels in persons who have been revaccinated are not yet available. Data from one epidemiologic study have suggested that vaccination may provide protection for at least 9 years after receipt of the initial dose (44). Decreasing estimates of effectiveness with increasing interval since vaccination, particularly among the very elderly (i.e., persons aged greater than or equal to 85 years), have been reported (79)."
Indications for Revaccination
"Routine revaccination of immunocompetent persons previously vaccinated with 23-valent polysaccharide vaccine is not recommended. However, revaccination once is recommended for persons aged greater than or equal to 2 years who are at highest risk for serious pneumococcal infection and those who are likely to have a rapid decline in pneumococcal antibody levels, provided that 5 years have elapsed since receipt of the first dose of pneumococcal vaccine.
Revaccination 3 years after the previous dose may be considered for children at highest risk for severe pneumococcal infection who would be aged less than or equal to 10 years at the time of revaccination. These children include those with functional or anatomic asplenia (e.g., sickle cell disease or splenectomy) and those with conditions associated with rapid antibody decline after initial vaccination (e.g., nephrotic syndrome, renal failure, or renal transplantation). Revaccination is contraindicated for persons who had a severe reaction (e.g., anaphylactic reaction or localized arthus-type reaction) to the initial dose they received. Persons aged greater than or equal to 65 years should be administered a second dose of vaccine if they received the vaccine greater than or equal to 5 years previously and were aged less than 65 years at the time of primary vaccination
. Elderly persons with unknown vaccination status should be administered one dose of vaccine (Figure_1
). The need for subsequent doses of pneumococcal vaccine is unclear and will be assessed when additional data become available. Because data are insufficient concerning the safety of pneumococcal vaccine when administered three or more times, revaccination following a second dose is not routinely recommended