Pneumococcal Vaccine

This document should be read in conjunction with the Summary of Product Characteristics (SmPC) issued by each vaccine manufacturer


What is pneumococcal disease?

Pneumococcal disease is a bacterial infection caused by streptococcus pneumoniae of which there are more than 90 serotypes. The organism is frequently found in the upper respiratory tract of healthy individuals worldwide. It has been estimated that carriage of the bacteria may range from 10% of adults to 50% of children attending day care facilities.

Over the years streptococcus pneumoniae has become resistant to many medications making the treatment of pneumococcal infections much more difficult. Prevention of disease through vaccination is now more important than ever. 

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What are the symptoms of pneumococcal disease?

Pneumococcal infection is responsible for 50% of community acquired pneumonia and bacteraemia where the overall mortality rate can be as high as 25%. It can also cause a wide variety of other infections including sinusitis, osteomyeltitis, bronchitis and otitis media.  

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Who is most at risk of pneumococcal disease?

Pneumococcal disease can lead to significant morbidity and mortality, particularly amongst the very young, the very old, those with impaired immunity and those with anatomic or functional asplenia.

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How is pneumococcal disease transmitted?

Transmission requires close contact with cases or carriers and is by droplet infection. Person-to person transmission of the organism is common. The incubation period can be difficult to determine but can be as short as 1-3 days. 

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Which pneumococcal vaccines are recommended in Ireland?

Pneumococcal conjugate vaccines and pneumococcal polysaccharide vaccines are licensed in Ireland

Pneumococcal conjugate vaccine (PCV)

PCV 13 - Prevenar 13 - contains polysaccharide from 13 of the most common capsular types (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F). It is recommended for the routine vaccination of all children born on or after 1st October 2010. This replaced PCV 7 (Prevenar 7) the pneumococcal conjugate vaccine introduced into the routine childhood immunisation programme in September 2008.

Pneumococcal polysaccharide vaccine (PPV)

This vaccine contains purified polysaccharide from 23 of the most common capsular types of streptococcus pneumoniae. This vaccine is recommended for those aged 65 years and older and "at-risk" adults and children over 2 years of age. To find out if vaccination is required please consult your copy of the PPV algorithm. It is available to download from here

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What impact has PCV had?

The introduction of PCV7 into the childhood immunisation schedule in the US in early 2000 resulted in a 69% reduction in the rates of invasive pneumococcal disease (IPD).

In Ireland the burden of IPD has also declined since the introduction of PCV7 to the childhood immunisation schedule in September 2008. It resulted in an 79% decease in the incidence of IPD in those aged under 2 years caused by the PCV7 vaccine serotypes.

In 2013 the incidence of confirmed cases of IPD declined by 28% compared with 2008 (with a 71% reduction in the <2 year old population)  

Figure 1: Impact of PCV on the burden of IPD caused by all serotypes in <2 year olds 2008-2013.

Figure 1

Source: Health Protection Surveillance Centre

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Why was PCV 13 introduced into the routine childhood schedule?

PCV 13 was introduced to provide protection against the same strains as PCV7 as well as additional protection from six serotypes of pneumococcal disease.

PCV13 has already been introduced into the routine childhood schedules of many countries such as the United Kingdom.  

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Who should NOT receive PCV?

Children should not get PCV if

  • They had a serious (life -threatening) allergic reaction to a previous dose or any of its constituents.

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When should vaccination be postponed?

As for any vaccine PCV vaccination should be postponed in those individuals who have an acute febrile illness. 

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What should one expect after vaccination with PCV 13?

In studies, most reactions after PCV13 were mild. They were similar to reactions reported after PCV7, which has been in use since 2000 in the US. Reported reactions varied by dose and age, but on average:

  • About half of children were drowsy after the shot, had a temporary loss of appetite, or had redness or tenderness where the shot was given.
  • About 1 out of 3 had swelling where the shot was given.
  • About 1 out of 3 had a mild fever

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Who is in the at risk groups and should be offered PCV?

Children up to 5 years of age with the following

- Asplenia or splenic dysfunction (including surgical splenectomy, sickle cell disease and coeliac disease)
- Candidates for, or recipients of, a cochlear implant
- Children under 5 years of age with a history of invasive pneumococcal disease, irrespective of vaccine history.
- Chronic renal disease or nephrotic syndrome
- Chronic heart, lung, or liver disease
- Complement deficiency (particularly early component deficiencies C1, C2, C3, C4)
- CSF leaks either congenital or complicating skull fracture or neurosurgery
- Diabetes mellitus
- Immunosuppressive conditions (e.g. some B- and T-cell disorders, HIV infection, leukaemia, lymphoma, Hodgkin's disease) and those receiving immunosuppressive therapies.
- Intracranial shunt
- Post haematopoietic stem cell transplant
- Solid organ transplant

Children between the ages of 5 and 18 years with the following

- Asplenia or splenic dysfunction (including surgical splenectomy, sickle cell disease and coeliac disease)
- Candidates for, or recipients of, a cochlear implant
- Complement deficiency (particularly early component deficiencies C1, C2, C3, C4)
- CSF leaks either congenital or complicating skull fracture or neurosurgery
- Immunosuppressive conditions (e.g. some B- and T-cell disorders, HIV infection, leukaemia, lymphoma, Hodgkin's disease) and those receiving immunosuppressive therapies.
- Intracranial shunt
- Post haematopoietic stem cell transplant
- Solid organ transplant

Immunisation with PCV followed by immunisation with PPV is recommended.for these groups of children.

PPV vaccine can be given after an interval of at least two months.

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Who should be vaccinated with PPV?

  • Everybody aged 65 years and over
  • Those aged over 2 years and less than 65 who have any of the following:

- Asplenia or splenic dysfunction (including surgical splenectomy, sickle cell disease and coeliac disease)
- Candidates for, or recipients of, a cochlear implant
- Children under 5 years of age with a history of invasive pneumococcal disease, irrespective of vaccine history.
- Chronic renal disease or nephrotic syndrome
- Chronic heart, lung, or liver disease
- Complement deficiency (particularly early component deficiencies C1, C2, C3, C4)
- CSF leaks either congenital or complicating skull fracture or neurosurgery
- Diabetes mellitus
- Immunosuppressive conditions (e.g. some B- and T-cell disorders, HIV infection, leukaemia, lymphoma, Hodgkin's disease) and those receiving immunosuppressive therapies.
- Intracranial shunt
- Post haematopoietic stem cell transplant
- Solid organ transplant

Vaccination is not recommended for healthy young adults, as there is little risk of pneumococcal infection.

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Who should not receive PPV?

PPV should NOT be given to those with a history of anaphylaxis to any of the vaccine constituents.

Precautions:
Acute severe febrile illness - defer until recovery.

Pregnancy:
PPV can be given if there is an urgent need for protection.

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Are there any side effects from vaccination?

The most commonly reported adverse reactions are localised redness and swelling at the injection site (>10%). If the vaccine is administered intradermally then a severe local reaction may occur.

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How often is vaccination with PPV required?

Revaccination with PPV can produce severe local reactions especially if given within 5 years of previous injection.

Aged 65 years and older

A once only booster vaccination is recommended 5 years after the first vaccination for those who received a previous dose at less than 65 years of age.

Those aged age 65 or older who have received one dose of PPV do not require any further dose regardless of immune status.

Less than 65 years of age

One booster vaccination is recommended 5 years after the first vaccination for those whose antibody levels are likely to decline rapidly e.g. asplenia, hyposplenism, immunosuppression including HIV infection, chronic renal disease, nephrotic syndrome or renal transplant.

Those who received PPV at less than 65 years of age require one further PPV booster at or after 65 years of age (five years after the previous dose)

If PPV was given during chemotherapy or radiotherapy a further dose vaccine is recommended 3 months after treatment.

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When is a 3rd dose of PPV required?

Adults whose antibodies are likely to decline rapidly should receive two doses of PPV while aged less than 65.

They will need a third dose of PPV when they turn 65 -if at least five years have passed since their last dose of PPV.

Depending on age and risk factors a person may require 1, 2 or 3 doses of PPV.

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If an immunosuppressed person aged 65 or over has received PPV on or after their 65th birthday do they need a further dose of PPV after 5 years?

No. A person aged 65 or over who is immunosuppressed should only receive one dose of PPV. This is because the immune response to the vaccine declines as people older.

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Can PPV vaccine be given at the same time as the influenza vaccine?

Yes. Pneumococcal vaccine may be given at the same time as influenza vaccine but at a different site.

As there is considerable overlap in the target groups for both vaccines, it is appropriate to offer PPV to patients (if indicated) when they attend for their influenza vaccine.

You can download a copy of the PPV algorithm. This outlines the groupings that need PPV and how many doses they require.

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Where can I find out more?

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 This page was updated on 19/04/2016