Adults At High Risk Of Ipd
Adults with immunocompromising conditions resulting in high risk of IPD, except HSCT, should receive 1 dose of Pneu-C-13 vaccine followed at least 8 weeks later by 1 dose of Pneu-P-23 vaccine, if not previously received. The dose of Pneu-C-13 vaccine should be administered at least 1 year after any previous dose of Pneu-P-23 vaccine. Refer to Immunocompromised persons for information about immunization of HSCT recipients.
Immunocompetent adults with conditions or lifestyle factors resulting in high risk of IPD should receive 1 dose of Pneu-P-23 vaccine, if not previously received. One dose of Pneu-P-23 vaccine is also recommended for all adults who are residents of long-term care facilities and should be considered for individuals who use illicit drugs.
Some experts also suggest a dose of Pneu-C-13 vaccine, followed by Pneu-P-23 vaccine, for immunocompetent adults with conditions resulting in high risk of IPD as this may theoretically improve antibody response and immunologic memory. However, Pneu-P-23 vaccine is the vaccine of choice for these individuals, and if only one vaccine can be provided, it should be Pneu-P-23 vaccine, because of the greater number of serotypes included in the vaccine.
Adults at highest risk of IPD should also receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization.
Table 4 – provides recommended schedules for adult immunization with pneumococcal vaccines.
Comparison With Previous Systematic Reviews
Regarding efficacy against IPD, our results are in accordance with previous meta-analyses addressing this outcome . Regarding the outcome PP, the pooled VE of our meta-analysis of clinical trials with a low risk of bias was similar to that reported by Moberley et al. . Contrarily, the latest meta-analyses found no statistically significant VE against PP. Their estimates were driven by the trials by Örtqvist et al. and Honkanen et al. , see Table 3.
The authors of a later validation study of the Ply-IC ELISA concluded that sensitivity and specificity of the assay were “insufficient for the performance of analytical epidemiological investigations or vaccine efficacy studies” . A validation study of the Ply-IC ELISA by an independent group came to a similar result . Moreover, that group showed that detection of antibodies to pneumolysin does not allow to differentiate between infection and mere colonization. Specificity of pneumolysin serology for the diagnosis of pneumococcal infection is further compromised by the fact that in addition to S. pneumoniae pneumolysin is expressed by other alpha-hemolytic streptococci such as S. viridans .
Measures Of Immune Response And Duration Of Immunity/protection
The 23-valent pneumococcal polysaccharide vaccine induces type-specific antibody responses to the capsular polysaccharide antigens of 23 serotypes of S. pneumoniae. The vaccine’s efficacy is estimated to be 50%70% in case-control studies. Vaccination is associated with a decrease in hospitalization and mortality.36
A head-to-head study with PCV13 and PPV23 in adults > 70 years who had received a single dose of PPV23 5 years ago revealed that the immune responses to 10 of 12 common serotypes were significantly higher in PCV13-immunized subjects13 . Studies on clinical efficacy and duration of protection are ongoing .
Ursula Wiedermann, in, 2013
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Description Of The Condition
The incidence of IPD is affected by age, with adults over 65 years and infants aged under two years at increased risk. In the United States, for example, the Centers for Disease Control and Prevention 2010 Active Bacterial Core Surveillance reports a relatively high yearly rate of IPD of 34.2 per 100,000 in infants younger than one year, a much lower rate of 3.8 per 100,000 between the ages of 18 and 34 years, and an increased rate of 36.4 per 100,000 in those older than 65 years . According to the WHO report from 2012, S. pneumoniae is the most common cause of severe communityacquired pneumonia in adults in Europe and the United States . The same report notes a high prevalence of proven pneumococcal infections in children with lobar pneumonia and bronchopneumonia .
What Do I Need To Tell My Doctor Before I Take Pneumococcal Polysaccharide Vaccine
- If you are allergic to pneumococcal polysaccharide vaccine any part of pneumococcal polysaccharide vaccine or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
- If you have an infection or an illness with a fever.
This is not a list of all drugs or health problems that interact with pneumococcal polysaccharide vaccine .
Tell your doctor and pharmacist about all of your drugs and health problems. You must check to make sure that it is safe for you to take pneumococcal polysaccharide vaccine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
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Clinical And Demographic Characteristics
A total of 190 RA patients were divided into four groups according to their ongoing anti-RA therapy. There was one group of 50 patients treated with TCZ as monotherapy , 62 patients treated with MTX alone , 54 patients who received a combination therapy consisting of TCZ and MTX and 24 patients who did not receive either drug . Prior to participating in this study, no patients had received a pneumococcal vaccination. Patients clinical and demographic characteristics are shown in .
Percentages of patients with twofold or more increases in serotype-specific IgG concentrations for serotypes 6B and 23F in the rheumatoid arthritis treatment groups. *p=0.046 and p=0.0009 . **p=0.005 and p=0.044 . Percentages of patients with 10-fold or more increases in OIs for serotypes 6B and 23F in the RA treatment groups. *p=0.019 . **p=0.027 and p=0.020 . ***p=0.028 . Data were compared using the 2 test or Fisher’s exact probability test. OIs, opsonisation indices Cont, RA control group MTX, methotrexate group TCZ, tocilizumab group TCZ+MTX, combination therapy group.
What Are The Possible Side Effects Of Pcv And Ppsv Vaccines
Kids may have redness, tenderness, or swelling where the shot was given. A child also might have a fever after getting the shot. There is a very small chance of an allergic reaction with any vaccine.
The pneumococcal vaccines contain only a small piece of the germ and so cannot cause pneumococcal disease.
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Why It Is Used
Pneumococcus is a type of bacteria that can cause severe infections, such as pneumonia, meningitis, and blood infections . These infections can be serious and can even cause death, especially in people who have impaired immune systems, older adults, and children younger than 2 years of age.
Doctors use two types of pneumococcal vaccines for routine immunization: pneumococcal conjugate or pneumococcal polysaccharide . The type of vaccine used depends on a person’s age.
- Pneumococcal conjugate
- PCV is recommended for routine use in babies who get 3 or 4 doses depending on your provincial recommendations.
- Children from 1 to 18 years old may be recommended to get an extra dose if they did not get all the doses as a baby. They may also need an extra dose if they have certain medical conditions that place them at high risk for infection with pneumococcus.
- The vaccine may be recommended for adults at high risk for infection with pneumococcus. This recommendation depends on the medical condition the adult has and on provincial recommendations.
Side Effects Of The Pneumococcal Vaccine
Like most vaccines, the childhood and adult versions of the pneumococcal vaccine can sometimes cause mild side effects.
These include:
- redness where the injection was given
- hardness or swelling where the injection was given
There are no serious side effects listed for either the childhood or adult versions of the vaccine, apart from an extremely rare risk of a severe allergic reaction .
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Are There Side Effects
Some people have side effects from the vaccine, but these are usually minor and last only a short time. It is quite common to have some swelling and soreness in the arm where the needle was given. Occasionally slight fever may occur. Other side effects – such as headache, a higher fever or fatigue may occur, but these are rare. You should always discuss the benefits and risks of any vaccine with your doctor.
Medical Conditions Resulting In High Risk Of Ipd
Table 1: Medical Conditions Resulting in High risk of IPD
Non-immunocompromising conditions
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.
Disease distribution
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.
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Why It Is Important To Do This Review
Decisions on vaccination policy against S. pneumoniae have great implications worldwide. To inform decision makers, evidence on the immunogenicity and clinical effects of the different vaccines must be fully compiled and the quality of the evidence must be appraised. Recommendations should preferably be based on direct comparisons. The last ACIP recommendation to vaccinate adults with PCV13 followed by PPSV23 is based on a trial comparing PCV to placebo, which demonstrated an impact on clinical endpoints that is considered larger than that of PPSV in other studies . The additional benefit of the conjugated pneumococcal vaccine over the nonconjugated vaccine has not previously been systematically summarised. We intend to summarise all studies directly comparing between PCV and PPSV alone.
A randomised controlled trial is the best study design to avoid systematic differences between intervention groups and therefore it is the optimal type of study to assess interventions in medicine . However, there are interventions that are less likely to be assessed by a RCT, in which case inclusion of observational studies in a review might be informative. Vaccination studies frequently measure only outcomes of immunogenicity rather than clinical disease, because of the long duration of followup required to monitor for disease and the rarity of events. Therefore, in order to assess clinical outcomes, we plan to include both RCTs and observational studies.
Ppsv23 Vaccination In At
It is recommended that at-risk children receive immunization with PPSV23 after they finish an immunization series with conjugated vaccines. In sickle cell pediatric patients, higher titers of the 7 serotypes contained in PCV7 were observed in patients receiving immunization with PCV7 series followed by PPSV23 compared to patients who received the PCV7 series alone. In HIV-positive pediatric patients receiving highly active antiretroviral therapy, a series of two PCV7 vaccinations followed by a PPSV23 vaccination increased antibody titers. Due to increased titers from PPVS23 vaccination, children who are immunocompromised should receive a single immunization with PPSV23 after the PCV13 vaccination series. For children who have sickle cell disease and/or functional or anatomical asplenia, two doses of PPSV23 are recommended. The first dose is recommended 8 weeks after finishing the PCV13 vaccine series. The second dose is recommended 3 to 5 years after the first dose according to the 2002 National Heart Lung and Blood Institutes Management of Sickle Cell Disease guidelines or 5 years after the first dose according to the 2010 Advisory Committee on Immunization Practices guidelines., Decreased duration between revaccination with PPSV23 has led to increased occurrences of mild vaccine-related adverse events in adults and should be considered when deciding PPSV23 revaccination scheduling in pediatric sickle cell patients.
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The Different Types Of Pneumococcal Vaccine
The type of pneumococcal vaccine you’re given depends on your age and health. There are 2 types.
Pneumococcal conjugate vaccine is used to vaccinate children under 2 years old as part of the NHS vaccination schedule. It’s known by the brand name Prevenar 13.
Children at risk of pneumococcal infections can have the PPV vaccine from the age of 2 years onwards. The PPV vaccine is not very effective in children under the age of 2.
Booster Doses Of Pneumococcal Vaccine
If you’re at increased risk of a pneumococcal infection, you’ll be given a single dose of the PPV vaccine.
But if your spleen does not work properly or you have a chronic kidney condition, you may need booster doses of PPV every 5 years.
This is because your levels of antibodies against the infection decrease over time.
Your GP surgery will advise you on whether you’ll need a booster dose.
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Characteristics Of Included Studies
Of the 14 studies, two studies were randomized controlled trials . However, since only data from one study arm were relevant for our research question, we treated both trials as cohort studies. The remaining studies were prospective or retrospective cohort studies, and one study had a cross-sectional design . The majority of studies comprised resident elderly populations , the remaining included only patients with chronic obstructive pulmonary disease , patients with a history of community-acquired pneumonia or renal transplant recipients . Five studies had a longitudinal design in which the same individuals received a primary dose and a revaccination with PPSV-23 one to ten years later .
Table 1 Characteristics of included studies
In 6 studies two different study groups were compared: one group consisted of participants who had received a primary PPSV-23 dose, and the second group comprised those who had received one or more than one PPSV-23 revaccination doses after 313 years. One study compared participants who had received at least three PPSV-23 doses as compared to those who had received a primary or second dose of PPSV-23 two studies compared three study groups in which participants had received a first, second or third dose of PPSV-23 . In most included studies, participants of the revaccination group were older and/or had more underlying comorbidities as compared to participants who received a primary PPSV-23 dose .
Table 2 Characteristics of included studies
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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Who Should Not Get The Pneumococcal Polysaccharide Vaccine
Speak with your health care provider if you have had a life-threatening reaction to a previous dose of pneumococcal vaccine, or any component of the vaccine.
Children under 2 years of age should not receive the pneumococcal polysaccharide vaccine because it is not effective in young children. These children receive the pneumococcal conjugate vaccine starting at 2 months of age.
There is no need to delay getting immunized because of a cold or other mild illness. However, if you have concerns speak with your health care provider.
Safety Of Primary Vaccination And Revaccination With Ppsv
Ten of 14 studies compared frequency and/or severity of AEs after primary and revaccination doses with PPSV-23 . In four studies, safety of 3 doses was assessed . Safety data were collected through patient diaries , by analyzing ICD-9 codes and/or medical records of vaccinated subjects or by telephone interview of vaccinees .
There was a wide range of reported safety endpoints ranging from two to seven local AEs, such as redness, swelling or limitation of arm movement, and from five to twelve systemic AEs, such as arthralgia, fatigue, fever, headache, nausea, myalgia or rash. Additionally, local and/or systemic AEs were graded as mild, moderate or severe in the majority of the studies.
Frequency of local and systemic AEs differed widely between the six studies in which patient diaries were used . For example, fever ranged from 0 to 9% after the primary dose and from 2 to 10% after revaccination dose, any headache from 2 to 61% in primary vaccinated and from 13 to 57% in revaccinated individuals. Limitation of arm movement ranged from 4 to 31% after primary and from 13 to 47% after revaccination.
In studies that used ICD-9 codes to assess differences in vaccine-related unplanned medical visits, differences were smaller and ranged from 0.3 to 1.3% after primary and from 0.7 to 1.9% after revaccination doses .
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Description Of The Intervention
A major factor affecting the incidence of IPD and pneumococcal pneumonia is the serological immunity against S. pneumoniae. Protection is serotypespecific and can be acquired through disease or vaccination. Pneumococcal vaccines are active vaccines composed of the pneumococcal capsular polysaccharide. The pneumococcal vaccines include the unconjugated polysaccharide vaccines and the conjugated polysaccharide vaccines . PPSV14 became available in 1977, replaced by the PPSV23 in 1983. The first conjugated vaccine was licensed for infants in 2000 and was composed of seven pneumococcal serotypes , replaced in 2010 by PCV10 and PCV13 targeting additional serotypes . Current vaccines include the unconjugated 23valent polysaccharide vaccine and the conjugated 10 and 13valent polysaccharide vaccine . The serotypes included in each vaccine are detailed in . Routine use of the conjugated vaccine as part of an immunisation programme has been shown to significantly reduce the incidence of disease caused by vaccinetype serotypes , not only in the children who were vaccinated but also in groups that were not vaccinated , an effect known as ‘herd immunity’ . This effect is well known with PCV7 . Early data on the impact of PCV13 on adult IPD have recently been published . Yet, despite this effect, IPD continues to occur in the elderly, even with VTs.