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
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.
Number And Timing Of Doses
Vaccinate all children younger than 2 years old with PCV13. The primary series consists of 3 doses routinely given at 2, 4, and 6 months of age. You can administer the first dose as early as 6 weeks of age. CDC recommends a fourth dose at 12 through 15 months of age. For children vaccinated when they are younger than 12 months of age, the minimum interval between doses is 4 weeks. Separate doses given at 12 months of age and older by at least 8 weeks.
The number and timing of doses for older children and adults depends on the medical indication, prior pneumococcal vaccination, and age. See Pneumococcal Vaccination: Summary of Who and When to Vaccinate for all pneumococcal vaccine recommendations by vaccine and age.
Summarizes how to implement adult pneumococcal vaccination recommendations.
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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.
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.
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How Do You Get Immunised Against Pneumococcal Disease
You can only get pneumococcal vaccines on their own, not as a combination vaccine. Different vaccines protect against different types of pneumococcal disease. They are all given as a needle.
There are 2 types of pneumococcal vaccine:
- Pneumovax 23 – PDF 21 KB – covers 23 strains of pneumococcal disease.
The type of vaccine used and the dosage schedule will depend on age and any conditions that put people at higher risk of getting pneumococcal disease. Your doctor can tell you which vaccine they will use for your pneumococcal immunisation.
Who Should Not Get Vaccinated Or Should Wait
- Anyone who has had a lifeâthreatening allergic reaction to any component of the vaccine Prevnar 7 or any vaccine containing diphtheria toxoid: CDC.gov/Vaccines/VPD/Pneumo/Public/Index.html
- Anyone who is moderately or severely ill when the shot is scheduled should wait until feeling better
- For information regarding additional warnings and precautions, please visit: CDC.gov/Vaccines/VPD/Pneumo/HCP/Recommendations.html#Contraindications-Precautions
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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.”
Infants And Children Who Have Not Previously Received Pcv7 Or Pcv13
Indian Academy of Pediatrics recommends 3 doses at 6, 10 and 14weeks with a booster at15 mo. Infants receiving their first dose at age < 11 mo should receive 3 doses of PCV13 at intervals of approximately 4 weeks with a booster at 15 mo. Children Aged 1223 Months should receive 2 doses with an interval of at least 8 weeks between doses. Unvaccinated healthy children aged 2459 mo should receive a single dose of PCV13.
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Who Should Get Vaccinated Against It
While pneumococcal disease can affect people of all ages, certain people are at a higher risk. Children under the age of 2 and adults over 65 have a higher risk of this illness than other adults and children, even if they have no other medical problems. Because of this, the Centers for Disease Control and Prevention recommends these two age groups be routinely vaccinated against this bacteria.
People between the ages of 2 and 64 typically dont require a pneumococcal vaccine if they have no other medical conditions. However, adults and children in this age range with certain health conditions may need additional doses of the vaccine.
Examples of these conditions include:
People who smoke
This is not a full list of situations where extra doses of a pneumococcal vaccine may be needed. Its recommended you speak with your healthcare provider to see if you should be vaccinated.
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.
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What To Know About Mild Side Effects
As with any vaccine, you may experience some mild side effects after receiving the pneumococcal vaccine.
Mild side effects vary depending on which vaccine you receive. The side effects will usually go away within a few days.
Possible side effects of the PCV13 vaccine include:
- redness or discoloration, pain, or swelling at the site of the shot
- sleepiness or drowsiness
- mild fever
What To Do If Your Child Is Unwell After The Vaccine
Its possible that your child may feel unwell after receiving a dose of the pneumococcal vaccine. Should this happen, there are ways to help ease their symptoms.
If your child has a fever, try to keep them cool. You can do this by providing cool liquids for them to drink and ensuring theyre not wearing too many layers.
Tenderness, redness or discoloration, and swelling at the site of the shot can be eased by applying a cool compress. To do this, wet a clean washcloth with cool water and place it gently on the affected area.
Symptoms like fever and pain at the site of the shot may be alleviated using over-the-counter medications like acetaminophen or ibuprofen . Be sure to use the infant formulation and to carefully follow the dosing instructions on the product packaging.
Prior to being approved for use, the safety and effectiveness of all vaccines must be rigorously evaluated in clinical trials. Lets take a look at some of the research into the effectiveness of pneumococcal vaccines.
A evaluated the effectiveness of the PCV13 vaccine in children. It found that:
- The vaccine effectiveness of PCV13 against the 13 pneumococcal strains included in the vaccine was 86 percent.
- The vaccine effectiveness against pneumococcal disease due to any strain of S.pneumoniae was 60.2 percent.
- The effectiveness of PCV13 didnt differ significantly between children with and without underlying health conditions.
The CDC also notes that more than
You shouldnt get the PCV13 vaccine if youre:
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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
How Are Cvs Pharmacy And Minuteclinic Different
At the pharmacy, vaccinations for adolescents through seniors are administered by a certified immunizationâtrained pharmacist. Age and state restrictions apply. No appointment necessary.
At MinuteClinic, vaccinations for children all the way through seniors are administered by a nurse practicioner or a physician associate.* No appointment necessary.
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Whats The Difference Between Pcv13 And Ppsv23
|helps protect you against 13 different strains of pneumococcal bacteria||helps protect you against 23 different strains of pneumococcal bacteria|
|usually given four separate times to children under two||generally given once to anyone over 64|
|generally given only once to adults older than 64 or adults older than 19 if they have an immune condition||given to anyone over 19 who regularly smokes nicotine products like cigarettes or cigars|
- Both vaccines help prevent pneumococcal complications like bacteremia and meningitis.
- Youll need more than one pneumonia shot during your lifetime. A 2016 study found that, if youre over 64, receiving both the PCV13 shot and the PPSV23 shot provide the best protection against all the strains of bacteria that cause pneumonia.
- Dont get the shots too close together. Youll need to wait about a year in between each shot.
- Check with your doctor to make sure youre not allergic to any of the ingredients used to make these vaccines before getting either shot.
- a vaccine made with diphtheria toxoid
- another version of the shot called PCV7
- any previous injections of a pneumonia shot
- are allergic to any ingredients in the shot
- have had severe allergies to a PPSV23 shot in the past
- are very sick
Administration Of Pneumococcal Vaccine
The usual dose is 0.5 mL IM for PCV13 and 0.5 mL IM or subcutaneous for PCSV23.
PCV13 is recommended as a 4-dose IM series for infants at age 2, 4, 6, and 12 to 15 months. Children aged 7 to 59 months who have not been vaccinated with PCV7 or PCV13 previously should be given 1 to 3 doses of PCV13, depending on their age at the initiation of the vaccination series and the presence of medical conditions. Children aged 24 to 71 months with chronic medical conditions that increase their risk of pneumococcal disease and who have received 3 doses of PCV13 should be given 1 dose of PCV13 at least 8 weeks after the most recent dose if they received less than 3 doses of PCV13, they should be given 2 doses of PCV13 at least 8 weeks apart. Interruption of the vaccination schedule does not require starting the entire series over or giving extra doses.
Children at high risk of pneumococcal disease should be given a dose of PPSV23 at age 24 months at least 8 weeks after the most recent dose of PCV13.
Children aged 14 to 59 months who have received a complete age-appropriate series of PCV7 should be given a single supplemental dose of PCV13.
Adults 65 years with no medical conditions listed above should be given PCV13 first, followed by PPSV23 at least 1 year later. If people have already been vaccinated with PPSV23, PCV13 should be given at least 1 year after the most recent dose of PPSV23.
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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.
Who Should Get Pneumococcal Vaccines
CDC recommends pneumococcal vaccination for all children younger than 2 years old and all adults 65 years or older. In certain situations, older children and other adults should also get pneumococcal vaccines. Below is more information about who should and should not get each type of pneumococcal vaccine.
Talk to your or your childs doctor about what is best for your specific situation.
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Groups At Risk Of Ipd
People who are immunocompromised and unable to mount an adequate immune response to pneumococcal capsular antigens have the highest risk of IPD.2,4,34 This includes people with asplenia.
Greater risk and/or severity of IPD
- excessive alcohol consumption
- certain non-immunocompromising chronic medical conditions2,34,42,43
Indigenous populations in developed countries, including Aboriginal and Torres Strait Islander people in Australia, have a disproportionately high burden of IPD
Young children and elderly people have the highest incidence of invasive pneumococcal disease .37,38,45 Disease burden is also disproportionately high in Aboriginal and Torres Strait Islander people.1,2