Persons With Chronic Diseases
Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional information about vaccination of people with chronic diseases.
Asplenia or hyposplenia
Hyposplenic or asplenic individuals should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine, followed by a booster dose of Pneu-P-23 vaccine. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.
Chronic kidney disease and patients on dialysis
Individuals with chronic kidney disease should receive age appropriate pneumococcal vaccines. Children less than 18 years of age with chronic kidney failure or nephrotic syndrome, should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine. Adults with chronic kidney failure should receive Pneu-P-23 vaccine. Adults with nephrotic syndrome should receive Pneu-C-13 and Pneu-P-23 vaccine. Due to the decreased immunogenicity and efficacy of Pneu-P-23 vaccine in children and adults with chronic kidney failure, 1 booster dose of Pneu-P-23 vaccine is recommended. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.
Chronic lung disease, including asthma
Chronic heart disease
Chronic liver disease
Endocrine and metabolic diseases
Non-malignant hematologic disorders
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.
When You Or Your Child Must Not Be Given It
Do not have PNEUMOVAX 23 if:
- you have an allergy to PNEUMOVAX 23 or any of the ingredients listed at the end of this leaflet
- the expiry date on the pack has passedIf the vaccine is used after the expiry date has passed, it may not work.
If you are not sure whether you or your child should be given PNEUMOVAX 23, talk to your doctor.
Do not give PNEUMOVAX 23 to children under 2 years of age. The safety and effectiveness of PNEUMOVAX 23 in children below the age of 2 years have not been established.
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Medical Conditions Resulting In High Risk Of Ipd
Table 1: Medical Conditions Resulting in High risk of IPD
IPD is more common in the winter and spring in temperate climates.
Spectrum of clinical illness
Although asymptomatic upper respiratory tract colonization is common, infection with S. pneumoniae may result in severe disease. IPD is a severe form of infection that occurs when S. pneumoniae invades normally sterile sites, such as the bloodstream or central nervous system. Bacteremia and meningitis are the most common manifestations of IPD in children 2 years of age and younger. Bacteremic pneumococcal pneumonia is the most common presentation among adults and is a common complication following influenza. The case fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons. Bacterial spread within the respiratory tract may result in AOM, sinusitis or recurrent bronchitis.
Worldwide, pneumococcal disease is a major cause of morbidity and mortality. The World Health Organization estimates that almost 500,000 deaths among children aged less than 5 years are attributable to pneumococcal disease each year. In Canada, IPD is most common among the very young and adults over 65 years of age.
What Are The Side Effects
Prior to its approval, Prevnar 20 was studied in six clinical trials. Across these studies, reported side effects were similar for all ages. Most of them were mild to moderate in severity. Like many other vaccines, pain at the injection site is reported as the most common side effect.
Additional common side effects of Prevnar 20 can include:
Injection site swelling
Although most of these side effects happened within 7 to 10 days of the shot, less than 2% of people experienced one or more serious adverse events within 6 months. However, it hasnt been confirmed that these events were due to the vaccine.
The safety of Prevnar 20 was studied in people who have no history of pneumococcal vaccination, in individuals who have previously received Prevnar 13, and in individuals who have previously received Pneumovax 23. No notable safety differences were seen between the vaccines.
Next, well discuss who should receive Prevnar 20.
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Side Effects Of The Pneumococcal Vaccine In Adults And Older Children
Mild side effects of the pneumococcal polysaccharide vaccine , the version of the pneumococcal vaccine given to adults and children over the age of 2, include:
- mild soreness or hardness at the site of the injection lasting 1 to 3 days
- a slightly raised temperature
More serious side effects of the PPV vaccine, such as allergic reactions, are rare.
How Do Inactivated Bacterial Vaccines Work
Inactivated bacterialvaccines are sterile biologic products that provide acquired immunity against certain bacterial infections. Inactivated bacterial vaccines work by stimulating the bodys immune system to produce antibodies against specific types of bacteria, and protect a person from becoming infected when exposed to these bacteria.
Inactivated bacterial vaccines are made from proteins or fragments of disease-causing bacteria grown inculture and then killed to prevent them from causing disease. Inactivated bacterial vaccines also contain substances that preserve and stabilize the vaccine, and boost immune response.
The main component of inactivated bacterial vaccines is the bacterial antigen against which the immune system produces antibodies. If exposed to the particular bacterial infection later in life, the immune system of the vaccinated person identifies the bacteria by the antigen, attacks and kills the bacteria, preventing illness.
Some inactivated bacterial vaccines are conjugated with tetanus or diphtheria bacterial toxoids to improve the immune response. Toxoids are toxins that are chemically altered to eliminate toxicity, but can be recognized as bacterial antigens by the immune system.
Inactivated bacterial vaccines do not provide as strong or long-lasting immunity as weakened live vaccines do, but are effective for people with compromised immunity. Inactivated bacterial vaccines provide immunity against the following bacterial infectious diseases:
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Who Should Not Get These Vaccines
Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below specific to pneumococcal vaccines and ask your or your childs doctor for more information.
Children younger than 2 years old should not get PPSV23. In addition, tell the person who is giving you or your child a pneumococcal conjugate vaccine if:
You or your child have had a life-threatening allergic reaction or have a severe allergy.
- Anyone who has had a life-threatening allergic reaction to any of the following should not get PCV13:
- A shot of this vaccine
- An earlier pneumococcal conjugate vaccine called PCV7
- Any vaccine containing diphtheria toxoid
You or your child are not feeling well.
- People who have a mild illness, such as a cold, can probably get vaccinated. People who have a more serious illness should probably wait until they recover. Your or your childs doctor can advise you.
Which Pneumonia Vaccine Is Best
There is no best pneumonia vaccine. The two available pneumonia vaccines are different, and which one is best for you depends on how old you are and whether or not you have certain medical conditions.
The main difference between Prevnar 13 and Pneumovax 23 is the number of pneumococcus strains the vaccine protects against.
PPSV23 contains polysaccharides from 23 types of pneumococcal bacteria and is mainly given to older adults.
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Vaccines For Children Program
The Vaccines for Children Program provides vaccines to children whose parents or guardians may not be able to afford them. A child is eligible if they are younger than 19 years old and meets one of the following requirements:
- American Indian or Alaska Native
If your child is VFC-eligible, ask if your doctor is a VFC provider. For help in finding a VFC provider near you, contact your state or local health departments VFC Program Coordinator or call CDC at 1-800-CDC-INFO .
What Is Pneumococcal Polysaccharides Vaccine
Pneumococcal disease is a serious infection caused by a bacteria that can infect the sinuses, inner ear, lungs, blood, and brain. These conditions can be fatal.
Pneumococcal polysaccharides vaccine is used to help prevent disease caused by pneumococcal bacteria. This vaccine contains 23 different types of pneumococcal bacteria.
PPSV is for use in adults 50 years and older, and in people at least 2 years old who have an increased risk of developing pneumococcal disease due to certain medical conditions.
The Centers for Disease Control and Prevention recommends this vaccine in adults 65 years and older even if they had a pneumococcal vaccine before the age of 65.
This vaccine helps your body develop immunity to the disease, but will not treat an active infection you already have.
Like any vaccine, pneumococcal polysaccharides vaccine may not provide protection from disease in every person.
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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.
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.
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.
How Much Will It Cost
At this time, Prevnar 20s list price hasnt been announced. However, this vaccine will likely be common for older adults, and its expected that Medicare will cover the bill. Pneumococcal vaccines are a cost-free benefit of Medicare Part B, and people with original Medicare or Medicare Advantage can receive covered pneumococcal vaccines with specific providers.
If you have Medicaid, check with your state Medicaid agency to see which vaccines are offered. Many Medicaid plans pay for some vaccines, but specific coverage varies.
All Health Insurance Marketplace plans and many private plans cover pneumococcal vaccines when provided by an in-network provider, but costs can vary depending on the specific insurance plan.
For people without insurance or adequate coverage, financial assistance and coupon programs may be available. Check back with GoodRx to find more ways to save and make your vaccinations more affordable.
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How Supplied/storage And Handling
Pneumovax 23 is supplied as follows:
NDC 0006-4943-00 a box of 10 single-dose vials, color coded with a purple cap and stripe on the vial labels and cartons.
NDC 0006-4837-03 a box of 10 single-dose, pre-filled Luer-Lok syringes with tip caps, color coded with a violet plunger rod and purple stripe on the syringe labels and cartons.
Storage and Handling
- Store at 2-8°C .
- All vaccine must be discarded after the expiration date.
The vial stoppers, syringe plunger stopper and syringe tip cap are not made with natural rubber latex.
Interactions With Other Medicines And Other Forms Of Interactions
In Australia, the National Health and Medical Research Council advises that influenza vaccine can be administered concurrently with pneumococcal polysaccharide vaccine.Pneumovax 23 and Zostavax should not be given concurrently because concomitant use in a clinical trial resulted in reduced immunogenicity of Zostavax. In this trial, the immunogenicity of Pneumovax 23 was not affected by Zostavax. Consider administration of the two vaccines separated by at least 4 weeks.
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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 38Â°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.
What Is In This Leaflet
This leaflet answers some common questions about PNEUMOVAX 23 . It does not contain all the available information.
It does not take the place of talking to your doctor or pharmacist.
All medicines and vaccines have risks and benefits. Your doctor has weighed the risks of you being given PNEUMOVAX 23 against the benefits they expect it will have for you.
If you have any concerns about being given this vaccine, ask your doctor or pharmacist.
Keep this leaflet. You may need to read it again.
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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.
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
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
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Naplex Question Of The Week: Pneumococcal Vaccines
Which of the following patients would be recommended to receive Pneumovax 23 today? Select all that apply.
A. 70-year-old female who takes Humira for rheumatoid arthritis and has never received a pneumococcal vaccine as an adult
B. 45-year-old male who has diabetes and has never received a pneumococcal vaccine as an adult
C. 67-year-old male who has a left-ventricular ejection fraction of 35%, received a dose of Prevnar 13 two years ago, and received a dose of Pneumovax 23 six years ago
D. 29-year-old female who smokes a pack of cigarettes per day, received the live attenuated influenza vaccine a week ago, and has never received a pneumococcal vaccine as an adult
E. 83-year-old male who has COPD and received a dose of Pneumovax 23 ten years ago
A, B, C, and D are the correct answers.
Pneumococcal vaccination is an important tool to prevent Streptococcus pneumoniae infections, including pneumonia and meningitis. Two pneumococcal vaccines are primarily used in practice. Prevnar 13 is the pneumococcal conjugate vaccine . Pneumovax 23 is the pneumococcal polysaccharide vaccine . These vaccines are commonly administered in community pharmacies, but the recommendations on pneumococcal vaccine eligibility and timing in adults is not as straightforward as with some other vaccines.
For more details on the recommendations for pneumococcal vaccines in adults, visit the following link:
Age Recommendations And Dosing
Prevnar 13 is approved for use in children 6 weeks and older, and the CDC recommends it for children younger than 2 years old and people 2 years or older with certain medical conditions. Its given into the muscle, and its a 4-dose series for children between 2 and 15 months of age. For children who dont receive the vaccine at this time, a catch-up schedule is available.
Prevnar 20 is currently approved for use in adults at least 18 years old, but official CDC recommendations havent been established yet. Its given as a single-dose injection into the muscle.
Pneumovax 23 is approved for use in children 2 years and older at higher risk of infection and adults at least 50 years old. However, the CDC recommends it for all adults 65 years or older, people 2 through 64 years with certain medical conditions, and adults 19 through 64 years who smoke cigarettes. Its a single-dose injection given into the muscle or skin, but additional doses may be recommended for some people.
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