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Infection with Streptococcus pneumoniae (pneumococcus) is common and may produce a range of illnesses - some more serious than others, eg otitis media, meningitis, septicaemia and pneumonia.
Serious or life-threatening infection is seen more commonly in children, the elderly, patients who have had their spleen removed and in immunocompromised patients.
The vaccine most commonly used in the UK is a polyvalent vaccine containing purified capsular polysaccharide from each of the 23 types of pneumococcus which are responsible for the vast majority of serious pneumococcal infections seen in this country.
Children under the age of 2 are unlikely to develop an immune response to the polysaccharide form of vaccination and those who are considered to be at risk of serious pneumococcal infection should receive a conjugate vaccine (Prevenar®) containing 13 types of pneumococcus. The vaccines are both inactivated and contain no live organisms.
Pneumococcal vaccination schedule
A single dose of 23 polyvalent vaccine, with no repeat vaccination, is normally all that is required for individuals over the age of 5, with the following exceptions:
- Patients with no spleen
- Patients with splenic dysfunction
- Patients with renal disease including nephrotic syndrome
Antibody levels are more likely to decline rapidly in these individuals and they should receive further vaccinations at 5-yearly intervals. Routine checks of antibody levels prior to revaccination in these individuals is not required.
Childhood immunisation schedule
Since September 2006:
- Children aged 2 months will receive the pneumococcal conjugate vaccine (PCV) - Prevenar®.
- This will be at 2 months, 4 months and 13 months.
- All children aged over 2 months and under 2 years will be offered PCV as part of the catch-up campaign.
- Children at special risk of infection, who have received the conjugate vaccine, should also have the 23 polyvalent vaccine following their 2nd birthday to protect them from other forms of the organism. This should be given at least two months after the last dose of conjugate vaccine.
- At-risk children who present late for immunisation should be offered 2 doses of PCV1 before the age of 12 months, and a further dose at 13 months of age.
- At-risk children aged over 12 months and under 5 years should be offered a single dose of PCV. Please note that children in this age group who have asplenia or splenic dysfunction, or who are immunocompromised, require a second dose of PCV because this group may have a suboptimal immunological response to the first dose of vaccine.
Indications for pneumoccocal vaccination
Pneumococcal vaccination is recommended for all those in whom pneumococcal infection is likely to be more common or more dangerous. It is currently recommended in the following circumstances:
- All adults over the age of 65
- Children under the age of 5 who have previously had invasive pneumococcal disease.
Consider all patients over the age of 2 months with increased risk (base decision to immunise on clinical judgment).
|Pneumococcal clinical risk groups - those aged two months and over|
|Clinical risk group||Examples (base decision on clinical judgement)|
|Asplenia or dysfunction of the spleen||For example homozygous sickle cell disease and coeliac disease|
|Chronic respiratory disease||For example chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Patients with respiratory conditions caused by aspiration, or a neuromuscular disease (eg cerebral palsy) with a risk of aspiration.
Asthma is not an indication, unless continuous or frequently repeated use of systemic steroids (as defined in Immunosuppression below) is needed.
|Chronic heart disease||Patients requiring regular medication and/or follow-up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure.|
|Chronic renal disease||Includes nephrotic syndrome, chronic renal failure, renal transplantation.|
|Chronic liver disease||Includes cirrhosis, biliary atresia, chronic hepatitis.|
|Diabetes (requiring insulin or oral hypoglycaemic drugs)||Includes type I diabetes mellitus, or type 2 diabetes requiring oral hypoglycaemic drugs.
It does not include diabetes that is diet-controlled.
|Immunosuppression||Due to disease or treatment, including asplenia or splenic dysfunction and HIV infection at all stages.
Patients undergoing chemotherapy leading to immunosuppression. Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone 20 mg or more per day (any age), or for children under 20 kg, a dose of ≥1 mg/kg/day.
Some immunocompromised patients may have a suboptimal immunological response to the vaccine.
|Individuals with cochlear implants||It is important that immunisation does not delay the cochlear implantation. Where possible, pneumococcal vaccination should be completed at least 2 weeks prior to surgery to allow a protective immune response to develop. In some cases it will not be possible to complete the course prior to surgery. In this instance, the course should be started at any time prior to or following surgery and completed according to the immunisation schedule.|
cerebrospinal fluid leaks
|This includes leakage of cerebrospinal fluid such as following trauma or major skull surgery.|
|Individuals at occupational risk||There is a strong association between welding and the development of pneumococcal disease, particularly lobar pneumonia. Therefore, welders who have not received the pneumococcal polysaccharide vaccine (PPV23) previously, should be offered a single dose of 0.5ml of PPV23 vaccine.|
Contra-indications to pneumococcal vaccine
There are very few contra-indications to the giving of pneumococcal vaccine. The vaccine should not be given to individuals who have had:
- A confirmed anaphylactic reaction to a previous dose of the vaccine.
- A confirmed anaphylactic reaction to any component of the vaccine.
- Although the safety of the vaccine has not been formally assessed during pregnancy, the vaccine may be given if clinically indicated.
The only adverse reactions likely to be encountered with either vaccine are:
- Mild soreness and induration at the injection site.
- ± a low-grade fever.
Further reading & references
- Lobar pneumonia in welders, Industrial Injuries Advisory Council, Information Note, November 2010
- Turbyville JC, Mikita CP, Kumar M, Gross F; Asplenia. eMedicine, August 2008.
- Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (1997)
- Introduction of Prevenar 13 into the Childhood Immunisation Programme, Dept of Health, 9th Feb 2010.
- Immunisation against infectious disease - the Green Book; Dept of Health (latest edition)
- About vaccination, NHS Choices
|Original Author: Dr Hayley Willacy||Current Version: Dr Hayley Willacy||Peer Reviewer: Dr Hannah Gronow|
|Last Checked: 17/11/2011||Document ID: 540 Version: 5||© EMIS|
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.