How To Give Pneumococcal Vaccine

Acip Guidelines Aged 2

Any of the following conditions:

Chronic heart disease

Chronic lung disease

Diabetes mellitus Cerebrospinal fluid leak

Cochlear implant

Sickle cell disease and other hemoglobinopathies

Anatomic or functional asplenia

Chronic renal failure

Nephrotic syndrome

Diseases associated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease solid organ transplantation or congenital immunodeficiency

Dosage for high risk 2-5 years olds

• 1. Administer 1 dose of PCV13 if 3 doses of PCV were received previously
• 2. Administer 2 doses of PCV at least 8 weeks apart if fewer than 3 doses of PCV13 were received previously
• 3. Administer 1 supplemental dose of PCV13 if 4 doses of PCV7 or other age-appropriate complete PCV7 series was received previously
• 4. The minimum interval between doses of PCV is 8 wk
• 5. For children with no history of PPSV23 vaccination, administer PPSV23 at least 8 wk after the most recent dose of PCV13

How The Pneumococcal Vaccine Works

Both types of pneumococcal vaccine encourage your body to produce antibodies against pneumococcal bacteria.

Antibodies are proteins produced by the body to neutralise or destroy disease-carrying organisms and toxins.

They protect you from becoming ill if you’re infected with the bacteria.

More than 90 different strains of the pneumococcal bacterium have been identified, although most of these strains do not cause serious infections.

The childhood vaccine protects against 13 strains of the pneumococcal bacterium, while the adult vaccine protects against 23 strains.

Effectiveness Of The Pneumococcal Vaccine

Children respond very well to the pneumococcal vaccine.

The introduction of this vaccine into the NHS childhood vaccination schedule has resulted in a large reduction in pneumococcal disease.

The pneumococcal vaccine given to older children and adults is thought to be around 50 to 70% effective at preventing pneumococcal disease.

Both types of pneumococcal vaccine are inactivated or “killed” vaccines and do not contain any live organisms. They cannot cause the infections they protect against.

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Who Should Get Immunised Against Pneumococcal Disease

Anyone who wants to protect themselves against pneumococcal disease can talk to their doctor about getting immunised.

Pneumococcal immunisation is recommended for:

• infants and children aged under 5 years
• non-Indigenous adults aged 70 years and over without medical risk conditions for pneumococcal disease
• Aboriginal and Torres Strait Islander children aged under 5 years living in Northern Territory, Queensland, South Australia and Western Australia
• Aboriginal and Torres Strait Islander adults aged 50 years and over without medical risk conditions for pneumococcal disease
• infants under 12 months diagnosed with certain medical risk conditions for pneumococcal disease
• people over 12 months with certain medical risk conditions for pneumococcal disease

There are two types of pneumococcal vaccine provided free under the National Immunisation Program for different age groups and circumstances:

Refer to the NIP schedule for vaccine dosage information. Your doctor or vaccination provider will advise if you or your child have a specified medical risk condition.

Refer to the pneumococcal recommendations in the Australian Immunisation Handbook for more information.

What If It Is Not Clear What A Person’s Vaccination History Is

When indicated, vaccines should be administered to patients with unknown vaccination status. All residents of nursing homes and other long-term care facilities should have their vaccination status assessed and documented.

How long must a person wait to receive other vaccinations?

Inactivated influenza vaccine and tetanusvaccines may be given at the same time as or at any time before or after a dose of pneumococcus vaccine. There are no requirements to wait between the doses of these or any other inactivated vaccines.

Vaccination of children recommended

In July 2000, the American Academy of Pediatrics and the CDC jointly recommended childhood pneumococcal immunization, since pneumococcal infections are the most common invasive bacterial infections in children in the United States.

“The pneumococcal conjugate vaccine, PCV13 or Prevnar 13, is currently recommended for all children younger than 5 years of age, all adults 65 years or older, and persons 6 through 64 years of age with certain medical conditions,” according to the 2014 AAP/CDC guidelines. “Pneumovax is a 23-valent pneumococcal polysaccharide vaccine that is currently recommended for use in all adults 65 years of age or older and for persons who are 2 years and older and at high risk for pneumococcal disease . PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma.”

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How Long Does A Pneumonia Shot Last

Streptococcus pneumoniaevaccinepneumoniaStreptococcus pneumoniae

• Younger than 2 years old: four shots
• 65 years old or older: two shots, which will last you the rest of your life
• Between 2 and 64 years old: between one and three shots if you have certain immune system disorders or if youre a smoker

Children At High Risk Of Ipd

Infants at high risk of IPD due to an underlying medical condition should receive Pneu-C-13 vaccine in a 4 dose schedule at 2 months, 4 months and 6 months followed by a dose at 12 to 15 months of age. Table 3 summarizes the recommended schedules for Pneu-C-13 vaccine for infants and children at high risk of IPD due to an underlying medical condition by pneumococcal conjugate vaccination history.

In addition to Pneu-C-13 vaccine, children at high risk of IPD due to an underlying medical condition should receive 1 dose of Pneu-P-23 vaccine at 24 months of age, at least 8 weeks after Pneu-C-13 vaccine. If an older child or adolescent at high risk of IPD due to an underlying medical condition has not previously received Pneu-P-23 vaccine, 1 dose of Pneu-P-23 vaccine should be administered, at least 8 weeks after Pneu-C-13 vaccine. Children and adolescents at highest risk of IPD should receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization. Refer to Immunocompromised persons for information about immunization of HSCT recipients.

Table 3: Recommended Schedules for Pneu-C-13 Vaccine for Children 2 months to less than 18 years of age, by Pneumococcal Conjugate Vaccination History

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Who Shouldnt Get Prevnar 20

People who have had a severe allergic reaction in the past to any of the vaccines ingredients including diphtheria protein should not receive Prevnar 20. People who are 17 years or younger also shouldnt receive this vaccine.

At this time, the FDA didnt place any other restrictions on who can receive Prevnar 20. If youre unsure if you should receive this vaccine, your healthcare provider can give you more information.

Patients In Health Care Institutions

Residents of long-term care facilities should receive Pneu-P-23 vaccine. Refer to Recommendations for Use for information about pneumococcal vaccination of individuals at increased risk of IPD. Refer to Immunization of Patients in Health Care Institutions in Part 3 for additional information about vaccination of patients in health care institutions.

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Acip Guidelines Aged 6

Any of the following conditions:

Cerebrospinal fluid leak

Sickle cell disease and other hemoglobinopathies

Anatomic or functional asplenia

Chronic renal failure

Nephrotic syndrome

Diseases associated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease generalized malignancy solid organ transplantation or multiple myeloma

1. If neither PCV13 nor PPSV23 has been received previously, administer 1 dose of PCV13 now and 1 dose of PPSV23 at least 8 wk later

2. If PCV13 has been received previously but PPSV23 has not, administer 1 dose of PPSV23 at least 8 wk after the most recent dose of PCV13

3. If PPSV23 has been received but PCV13 has not, administer 1 dose of PCV13 at least 8 wk after the most recent dose of PPSV23

Heart, lung, diabetes, liver diseases in 6-18 year olds

• Chronic heart disease
• Chronic lung disease
• Diabetes mellitus
• Chronic liver disease
• If the patient has not received PPSV23, administer 1 dose of PPSV23
• If PCV13 has been received previously, then PPSV23 should be administered at least 8 wk after any prior PCV13 dose

What Is The Pneumococcal Vaccine

The pneumococcal vaccine is an injection given to protect your child from pneumococcal disease. Pneumococcal disease develops from an infection caused by pneumococcal bacteria. The infection may cause pneumonia or an ear infection. Pneumococcal disease is spread from person to person through coughing and sneezing. The vaccine comes in 2 forms, called pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine . Your child’s healthcare provider will tell you which form is right for your child.

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Indication For Pneumovax 23

PNEUMOVAX®23 is a vaccine indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine .

PNEUMOVAX 23 is approved for use in persons 50 years of age or older and persons aged 2 years who are at increased risk for pneumococcal disease.

PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine.

Common And Local Adverse Events

Pneumococcal conjugate vaccine

Studies of Pneu-C-13 vaccine indicated that irritability decreased appetite increased or decreased sleep and pain, swelling and redness at the injection site after the toddler dose and in older children, are common side effects. Low grade fever occurred in 20% to 30% or more of vaccine recipients. In adults over 50 years of age, the most commonly reported side effects included pain at the injection site, fatigue, headache and new onset of myalgia, with fever above 38°C occurring in approximately 3% of vaccine recipients.

Pneumococcal polysaccharide vaccine

Reactions to Pneu-P-23 vaccine are usually mild. Soreness, redness and swelling at the injection site occur in 30% to 60% of vaccine recipients and more commonly follow SC administration than IM administration. Occasionally, low grade fever may occur. Re-immunization of healthy adults less than 2 years after the initial dose is associated with increased injection site and systemic reactions. Studies have suggested that re-vaccination after an interval of at least 4 years is not associated with an increased incidence of adverse side effects. However, severe injection site reactions, including reports of injection site cellulitis and peripheral edema in the injected extremity, have been documented rarely with Pneu-P-23 vaccine in post-marketing surveillance, even with the first dose. Multiple re-vaccinations are not recommended refer to Booster doses and re-immunization.

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Recommendations For Pneumococcal Conjugate Vaccines In India

The burden of pneumococcal disease is the greatest among the underprivileged children in India. The PCVs are thus of public health importance and ideally should be available to all children. However the high cost of PCVs and the limited coverage of the currently available vaccine are impediments. GAVI has offered to supply PCV at a cost of 0.150.3 USD/dose to India for inclusion in the national immunization schedule and commits to extending this support until the year 2015. The risk of invasive pneumococcal disease is significantly lower in healthy children above the age of 2 y and thus benefit achieved with vaccination of these children is likely to be lower. Vaccination with single dose of PCV vaccine may be considered in children aged 25 y. Pneumococcal vaccination in not recommended in children aged 5 and above. The recommended dosage for PCV 13 is 0.5mL, and the vaccination route is intramuscular.

Concurrent Administration Of Vaccines

Pneumococcal vaccines may be administered concomitantly with other vaccines, with the exception of a different formulation of pneumococcal vaccine . There should be at least an 8 week interval between a dose of pneumococcal conjugate vaccine and a subsequent dose of Pneu-P-23 vaccine, and at least a 1 year interval between a dose of Pneu-P-23 vaccine and a subsequent dose of pneumococcal conjugate vaccine refer to Immunocompromised persons for information regarding administration of pneumococcal vaccines to HSCT recipients. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections. Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.

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How Does It Work

Prevnar 20 is a conjugate vaccine. This means that it contains pieces of sugar-like substances called polysaccharides that typically coat the bacteria but also hide it from our immune system. The vaccine uses only a certain portion of the bacteria not the bacteria itself so its unable to cause an infection.

This conjugate vaccine uses 20 slightly different polysaccharides that are specific to the 20 serotypes and attaches them to proteins that our immune systems can recognize. If the bacteria enters the body after the vaccination is administered, the immune system can recognize the polysaccharide molecule and release antibodies to fight the bacteria before it causes an infection.

Interchangeability Of 10vpcv And 13vpcv

There are no specific data on the interchangeability of 10vPCV and 13vPCV. It is preferable to complete a primary course of pneumococcal conjugate vaccine with the same formulation. However, if a child started their vaccination course with 10vPCV , it is acceptable to complete the course with 13vPCV

The only absolute contraindications to pneumococcal vaccines are:

• anaphylaxis after a previous dose of any pneumococcal vaccine
• anaphylaxis after any component of a pneumococcal vaccine

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Summary Of Information Contained In This Naci Statement

The following highlights key information for immunization providers. Please refer to the remainder of the Statement for details.

1. What

Streptococcus pneumoniae is a bacterium that can cause many types of diseases including invasive pneumococcal disease , and community-acquired pneumonia .

For the prevention of diseases caused by S. pneumoniae in adults, two types of vaccines are available in Canada: pneumococcal 23-valent polysaccharide vaccine containing 23 pneumococcal serotypes and pneumococcal 13-valent conjugate vaccine containing 13 pneumococcal serotypes.

NACI has been tasked with providing a recommendation from a public health perspective on the use of pneumococcal vaccines in adults who are 65 years of age and older, following the implementation of routine childhood pneumococcal vaccine programs in Canada.

• Immunization and vaccines

2. Who

Information in this statement is intended for provinces and territories making decisions for publicly funded, routine, immunization programs for adults who are 65 years of age and older without risk factors increasing their risk of IPD. These recommendations supplement the recent NACI recommendations on this topic that were issued for individual-level decision making in 2016.

3. How

4. Why

How Does It Compare To Other Pneumococcal Vaccines

Like Prevnar 20, Prevnar 13 is a conjugate vaccine that works in a similar way to protect you against pneumococcal disease. Pneumovax 23, on the other hand, is a polyvalent vaccine that works by producing antibodies against pneumococcal bacteria.

No vaccine is 100% effective at preventing disease, but all three pneumococcal vaccines Prevnar 13, Prevnar 20, and Pneumovax 23 are considered safe and effective for helping protect against pneumococcal disease. And this latest FDA approval demonstrates ongoing pneumococcal vaccine development, with more candidates currently in the pipeline.

Lets review some key differences between the vaccines.

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How Do I We Get The Vaccine

In Canada, all provinces and territories provide the pneumococcal conjugate vaccine, starting at 2 months of age. While the exact schedule will depend on where you live, usually two shots are given between 2 and 11 months of age and a booster at 12-15 months. Children at high risk of disease are given three shots , as well as the booster.

Unvaccinated children between 15 months and 5 years old should also get the vaccine. Your doctor or public health unit can tell you the number of shots your child will need and when.

All unvaccinated children and adolescents who are at high risk of serious infection should receive both the conjugate and the polysaccharide vaccine. The polysaccharide vaccine is at given at age 2 or later, with a booster 5 years after the first.

Who Should Get The Pneumococcal Vaccine And When Should It Be Given

The PCV7 vaccine that covered seven strains of pneumococcal bacteria, has now been updated to the PCV13 vaccine, which covers 13 strains. A PCV series begun with PCV7 should be completed with PCV13. A single additional dose of PCV13 is recommended for all children 14â59 months who have received an age-appropriate series of PCV7 and for all children 60â71 months with underlying specific medical conditions who have received an age-appropriate series of PCV7.

The PCV vaccine is recommended for the following children:

• All infants younger than 24 months should receive four doses of the vaccine, the first one at 2 months. The next two shots should be given at 4 months and 6 months, with a final booster that should be given at 12 to 15 months. Children who do not get their shot at these times should still get the vaccine. The number of doses and time between doses will depend on the child’s age.
• Healthy children ages 2 through 4 years who did not complete the four doses should receive one dose of the vaccine.

The PPSV vaccine is recommended for any adult ages 19 through 64 who smokes or has asthma and anyone ages 2 through 64 who is taking a drug or treatment that affects the body’s immune system. Examples would be long-term use of steroids, chemotherapy, or radiation therapy.

In addition, anyone ages 2 through 64 who has one of the following health conditions that affect the immune system should be vaccinated with PPSV:

• leaks of cerebrospinal fluid
• cochlear implant

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Who Should Not Get The Vaccine

People should not get the vaccine if they have had a life threatening allergic reaction to a previous dose.

Additionally, a person should not undergo vaccination if they have had an allergic reaction to medication containing diphtheria toxoid or an earlier form of the pneumonia vaccination .

Lastly, people who are sick or have allergic reactions to any of the ingredients of the vaccine should talk to a doctor before getting the shot.

A pneumonia shot will not reduce pneumonia. However, it helps prevent invasive pneumococcal diseases, such as meningitis, endocarditis, empyema, and bacteremia, which is when bacteria enter the bloodstream.

Noninvasive pneumococcal disease includes sinusitis.

There are two types of pneumonia shots available. Which type a person gets depends on their age, whether or not they smoke, and the presence of any underlying medical conditions.

The two types are:

• Pneumococcal conjugate vaccine : Healthcare providers recommend this vaccine for young children, people with certain underlying conditions, and some people over the age of 65 years.
• Pneumococcal polysaccharide vaccine : Healthcare providers recommend this vaccine for anyone over 65 years of age, people with certain underlying conditions, and people who smoke.

According to the

• roughly 8 in 10 babies from invasive pneumococcal disease
• 45 in 100 adults 65 years or older against pneumococcal pneumonia
• 75 in 100 adults 65 years or older against invasive pneumococcal disease